What is CPRS?
The Computerized Patient Record System (CPRS) is a Veterans
Health Information Systems and Technology Architecture (VistA) computer
application. CPRS enables you to enter, review, and continuously update all the
information connected with any patient. With CPRS, you can order lab tests,
medications, diets, radiology tests and procedures, record a patient’s
allergies or adverse reactions to medications, request and track consults,
enter progress notes, diagnoses, and treatments for each encounter, and enter
discharge summaries. In addition, CPRS supports clinical decision-making and
enables you to review and analyze patient data.
Using CPRS Documentation
Related Manuals
Computerized Patient
Record System Installation Guide Computerized Patient Record System Setup Guide
Computerized Patient
Record System Technical Manual
Computerized Patient
Record System Online Help
Clinical Reminders
Manager Manual
Clinical Reminders
Clinician Guide
Text Integration
Utility (TIU) Clinical Coordinator and User Manual
Consult/Request
Tracking User Manual
VistA Intranet
CPRS documentation is also available on the VistA intranet.
The intranet version is constantly updated and may contain more current
information than this print version. CPRS documentation is available on the
VistA intranet.
Online Help
Instructions, procedures, and other information are
available from the CPRS online help file. You may access the help file by
clicking Help | Contents from the menu bar or by pressing the F1 key while you
have any CPRS dialog open. Much of the information in this User Manual is also
in the CPRS online help.
CPRS Graphical User Interface (GUI)
CPRS was designed to run in both the Microsoft Windows
operating environment and on text-based terminals. The terminal or text-based
version of CPRS (also known as the List Manager version) is not described in
this manual. This manual describes the Windows version of CPRS.
The Organization of this Manual
This manual is organized in the way most people will use the
CPRS GUI. It begins with how to log on to the system and then how to select a
patient. The manual continues with an explanation of the features that are
available from each CPRS tab.
We hope this organization will help you understand the basic
layout of the CPRS GUI and provide you with information about the specific
tasks you will perform.
Conventions in the
CPRS Interface
Throughout CPRS, some items are always or almost always the
same. This section deals with a few of these conventions in the CPRS GUI
interface.
Entering Dates and Times into CPRS
CPRS generally allows users to enter time in several
different formats. Users can often enter month-day-year dates (such as
05/01/65) or users can sometimes spell out the month (November 22, 2001) or as
a date referenced from today (t-30 for a month in the past, today minus 30).
Users often can enter a time as well as a date. For tasks
such as medication ordering and administration, entering a time can be
critical. Times are entered as a 24-hour time, not with a 12-hour clock and an
a.m. and p.m. For example, the time 8 a.m. is entered as 08:00:00, whereas 8
p.m. is entered as 20:00:00.
Note:
The time 00:00 presents a challenge
because it can be ambiguous as to when it is. To address this issue, CPRS
changes the time of 00:00 to 00:01. This makes the time belong to a specific
day, increasing clarity. Similarly, if a user selects Midnight, CPRS makes the
time 23:59.
In some cases, users can also enter a date with no known
time (T@U). CPRS used to assign a time of 00:00 to this entry, but now, it will
not put a time in for this case.
CPRS now uses a more secure access method called two-factor
authentication (sometimes called 2FA). Two-factor authentication simply means
that you use your
Personal Identification Verification (PIV) card and your
Personal Identification Number (PIN) to gain access to CPRS. If you experience
a problem with two-factor authentication, you can select Cancel on the dialog
that requests a certificate and enter your access and verify code to log in to
CPRS.
Note: To use the new two-factor authentication,
each user’s Active Directory entry must be “Bound” for each VistA instance. So,
if you can access one VistA system, but a different one that you access does
not work, you will need to contact support to verify that your Active Directory
entry has been bound to all of the accounts you access.
To login to CPRS with your PIV card, follow these steps:
Double-click the CPRS icon on your desktop.
If the Connect To dialog appears, click the down-arrow,
select the appropriate account (if more than one exists), and click OK.
In the Windows Security dialog, select the certificate
associated with your PIV card and press <Enter>. If there are multiple
certificates, choose the one that is for “internal PIV authentication.” You can
see that by hovering over the name for the certificate as shown below.
Note:
If there is a problem with your PIV or PIN, you can select Cancel to revert to
using your access and verify codes.
Type your PIN into the dialog that appears and press
<Enter>.
If you lose your PIV card or forget it, there is an
alternative way to log into CPRS using your access and verify code. Each user
should be assigned an access code and a verify code. You will need to check
with your local facility to get your access and verify codes, if necessary.
To login to CPRS with your access and verify code, follow
these steps:
1.
Double-click the CPRS
icon on your desktop. The VistA logo window and the VistA Sign-on dialog will
appear.
2.
If the Connect To
dialog appears, click the down-arrow, select the appropriate account (if more
than one exists), and click OK.
3.
Type your access code
into the Access Code field and press the Tab key.
4.
Type the verify code
into the verify code field and press the Enter key or click OK.
Note: You can
also type the access code, followed by a semicolon, followed by the verify
code. Once you have done this press the Enter
key or click OK.
The VISTA Sign-on screen
After you log in to CPRS, the Patient Selection screen,
shown below, is the first thing to appear. You should now select a patient
record to view.
Example of the Patient Selection screen
To select a patient record, follow these steps:
1.
If you are just
opening CPRS, skip to step 2. Otherwise, select File | Select New Patient...
Note: If you have just entered orders or documents that are
unsigned, a screen will pop up asking you to review and sign the changes.
2.
Do one of the
following:
● Type the patient's full social security number with or
without dashes (000-44-4444 or 000444444) or type the full social security
number with “P” as the last character (000-44-4444p, or 000444444p).
● Type part of the patient’s last name or the patient’s
entire name (e.g. “CPRSp” or “CPRSpatient,One”).
●
Type the first letter
of the patient’s last name and the last four digits of the patient’s Social
Security number (c4444).
CPRS will try to match what you entered to a patient and
highlight that patient. The patient's name and other information will appear
below the Cancel button.
Note: CPRS now only auto-selects (highlights in blue and places
that entry in the field) a patient name if the user types enough characters to
uniquely identify a name in the list. If the user does not enter enough
characters to uniquely identify an item, CPRS waits until the user explicitly
selects an item using the mouse or the keyboard.
3.
Verify that the
correct patient is highlighted. If the correct patient is highlighted, click
OK. If the correct patient is not highlighted, scroll through to find the
correct patient, highlight the name, and then click OK.
Note: If CPRS finds more than one patient with the same last name
and same last four digits of the social security numbers, a box will popup
listing possible matches. Select the correct patient and click OK.
When you select OK, CPRS opens to the Cover Sheet (unless
you have set it to open to a different tab).
You can also use the radio buttons under the Patient List
heading (located on the left-side of the window) to group the patient list
according to provider, team, specialty, clinic, or ward. When you select a
specific list for a provider, team, specialty, clinic, or ward, CPRS will
display the associated patients in the Patients list box, followed by a line,
and then the comprehensive patient list. You can then scroll to find the name.
Your Clinical Coordinator will usually create the lists for the teams, wards,
and so on.
National Provider Identifier (NPI) Display in CPRS
If a provider’s NPI is listed in the NEW PERSON file (#200),
it will display in the provider selection lists in CPRS, as shown in the
example below:
The user will be able to hover over the NPI. However, the NPI will not display when a
provider is listed in the top section of the CPRS window, as shown below:
There are two other places where the NPI will not display
due to GUI restrictions:
● Tools | Graphing | Select/Define | Select Person
● Tools | Options | Notes | Notes | Default Cosigner
The screenshots in this manual that display a provider’s
name have not been updated with NPI data.
However, there will be a note near the screenshot that tells whether or
not the NPI will display.
How CPRS Sorts Names
VistA software uses a set of characters that include
uppercase and lowercase Latin alphabetic characters (A-Z, a-z), numbers (0-9),
and other special characters.
This is important because of how
names are sorted if the user is searching for a partial name. If VistA has
stored characters other than the Latin alphabetic and numeric, such as ñ, and
the user does a partial search (types in only part of the name, for example),
the names may not display in the order the user expects.
For example, if the system had patients or clinicians with
names like Pina, Piña,
Piñon, Pine, Pinto, Pitcher, Pitt, Pixon, and Pizzelo, it is
possible that the Piña and Piñon were entered with an ñ. If the user typed in
“pi” as what CPRS should search for, CPRS would display the names as shown
below:
Pina
Pine
Pinto
Pitcher
Pitt
Pixon
Pizzelo
Piña
Piñon
Note that Piña is after Pizzelo. This is because VistA sorts
these characters based on their numeric values in the character set that VistA
uses. For example, in that table, the number for lowercase “a” might be 97, “z”
might be 122, and “ñ” might be 241. Characters other than the uppercase and
lowercase Latin alphabetic characters and numbers, such as ñ or the tilde (~)
will display wherever their numeric equivalent falls, which is generally after
z.
Patient Selection Messages
When you select a patient record to open, you may receive
one or more of the following messages:
● Means Test
Required – This message tells you that the
patient’s ability to pay for medical services must be evaluated.
● Legacy Data
Available – This message would be found
only at a consolidated facility. It informs you that the selected patient has
data from the system you used before your site was consolidated that is not
being displayed and that you may want to access.
● Sensitive Patient
Record – This indicates that the record is
sensitive and may only be viewed by authorized users.
● Deceased Patient
– This message tells you that the selected
patient is deceased.
● Patient with Similar Name or Social Security Number – This
message appears if you enter only part of a patient’s name or the last four
digits of a social security number. If CPRS finds more than one match for what
you have entered, this message appears and CPRS presents the possible matches
so that you can select the right one.
Patient Lists
You or your Clinical Coordinator can create patient lists or
team lists that simplify tasks such as reviewing patient charts, ordering, and
signing orders and notes. These lists can be based on wards, clinics, teams, or
other groups. Users can create their own personal Patient Lists in the CPRS
GUI. When the user creates the list, the user designates if the list can be
viewed only by the owner (the person creating the list) or by all CPRS users.
Clinical Application Coordinators (CACs) can create and manage general patient
lists through the List Manager interface (the character-based version of
CPRS).
With patient lists you can:
● Quickly locate your patients without going through all the
patients in the list.
● Create lists for teams of clinicians who can sign or cosign
for each other.
● Tie notifications to teams, ensuring that all team members
receive necessary information about a patient.
Setting a Default Patient List
To make it easier for you to locate your patients, CPRS
enables you to set a default patient list. This is the list that will appear
when you launch CPRS. For example, if you work in a specific ward, you can set
the default patient list to be the list for that ward.
To set the default patient list, use these steps:
1.
If you are just
opening CPRS, skip to step 2. Otherwise, select File | Select New Patient....
2.
In the Patient
Selection screen, select the category in which you want to search for a
patient’s record by clicking the option button in front of the category
(Default, Providers, Teams, Specialties, Clinics, Wards, or All).
3.
In the list box below
the option button, click the item that narrows the search further (such as a
specific ward).
4.
If you select
something other than All, CPRS sorts the patient list and divides the list into
two parts: The names above the line are the names for the category and item you
selected; the names below the line make up a comprehensive patient list.
5.
To save the patient
list as your default list, click Save Patient List Settings.
6.
If you selected
“Clinics” in step 2, a dialog that resembles Figure A will appear.
This dialog enables the user to save kinds of clinic lists
7.
Select “Save For All
Days of Week” to set the clinic as the default patient list for all days of the
week.
-or-
select “Save For Current Day Only”
if you wish to set the clinic as the default for only the current day of the
week.
8.
Press OK.
Notifications
Notifications are messages that provide information or
prompt you to act on a clinical event. Clinical events, such as a critical lab
value or a change in orders, trigger a notification to be sent to all
recipients identified by the triggering package (such as Lab, CPRS, or
Radiology).
There are two different listings for
Notifications, Provider-centric and patient-centric.
Provider-centric notifications are shown on the Patient selection screen and
all pertain to the user that is logged in. The user brings up Patient-centric
notifications or alerts in their own dialog box by selecting an item from the
File menu.
● Provider-centric:
The listing on the Patient Selection screen shows all notifications for the
provider
Provider-centric
view of Notifications on the Patient Selection screen.
●
Patient-Centric: This listing is reached by
selecting File | View Patient’s Notifications…. The main difference is that all
notifications listed in this dialog relate to the current patient only. The
last column labeled Mine tells whether the notification belongs to the logged
in provider as well.
This screen
capture shows how the user can select File | View Patient’s Notifications to
bring up the dialog below.
After a patient is selected, the user can view all notifications
for the selected patient. New columns include “My To Do” and the “Ordering
Provider” and the user can process, defer, or close the dialog. The date range
of displayed alerts is also customizable.
Action, Informational, and Long Text
Informational Alerts
● Action alerts: When you process notifications that require an action,
such as signing an order, CPRS brings up the chart tab and the specific item
(such as a note requiring a signature) that requires action.
● Informational
alerts: CPRS places an “I” before
“information-only” notifications. Once you view (process) information-only
notifications, CPRS deletes them.
● Long Text
Information alerts: CPRS places an “L”
before a long alert. Long alerts have more text than will fit on one line as
alerts are normally displayed. Processing the alert will bring up a dialog with
additional actions.
Action Alerts Require User
Interaction
For action alerts, users can
select the alert and CPRS will take them to the appropriate tab to complete the
action. This may be to view a lab result, sign orders or notes, respond to
System for Mammogram Results Tracking (SMART) notifications, etc.
SMART notifications are new
with CPRS v31b. When users process a SMART notification, they are taken to a
progress note title containing a Reminder dialog for them to complete.
From the main listing, users
can also Remove, Renew, Forward or Defer notifications.
● Removing notifications is the same as deleting them. A new
parameter (ORB REMOVE) enables you site to identify which notifications can be
removed without processing.
● Renewing notifications is useful when a user is processing a view
alert, such as an abnormal lab result, and decides that the alert should not go
away after the user views it. In this case, the user can renew the alert and it
will still be there the next time the user logs in to CPRS.
● Forwarding notifications enables users to send an alert to someone
else at the site. The user can choose from the list of names that is in your
site’s New Person file.
● Deferring notifications enables a user to defer a notification for a
period of time from 5 minutes to 14 days. Deferring will remove the
notification from the display for the designated period of time, after which,
it will display again. Users can defer notifications as many times as they
choose until the system removes them.
Example of the Defer Patient Notification option
A dialog shows that the notification was successfully deferred
Note: As a default, all
Notifications are disabled. Information Resources Management (IRM) staff and
Clinical Coordinators enable specific notifications by setting site parameters
through the Notifications Management Menus in the List Manager version of CPRS.
These specific Notifications are initially sent to all users. Users can then
disable unwanted Notifications as desired, through List Manager’s Personal
Preferences. Some notifications are mandatory and cannot be disabled.
Notifications are retained for a predetermined amount of
time (up to 30 days), after which they may be sent to another destination, such
as your MailMan surrogate or your supervisor. Confer with your clinical
coordinator to establish and set up these options. You can also confer with your
clinical coordinator to select what types of notifications you will receive.
Some notifications are mandatory, however, and cannot be disabled.
Clinical Notifications are displayed on the bottom of the
Patient Selection screen when you log in to CPRS. Only notifications for your patients or notifications that have
been forwarded to you are shown.
Sorting Notifications and Viewing Comments of
Forwarded Alerts
To enable users to decide which of their Notifications or
Alerts they would like to process first, the format for displaying
Notifications in the CPRS GUI has been changed to columns that enable users to
sort their Notifications based on column heading:
● Info (information alerts are preceded with an “I”)
● Patient name (alphabetical or reverse alphabetical)
● Location (patient location, if known, alphabetical or
reverse alphabetical)
● Urgency (valued HIGH, Moderate, or low as indicated by the
CPRS parameter ORB URGENCY. TIU alerts are given a Moderate urgency value.
Other alerts without a parameter value are given an urgency of low.)
● Alert Date/Time (date/time the alert was triggered, newest
to oldest or oldest to newest)
● Message (alert message or text, alphabetical or reverse
alphabetical)
● Forwarded By/When (sorts alerts alphabetically and then by
time for the same forwarding person)
This graphic
shows the alerts sorted by date. Clicking a heading will sort the alerts by
that heading
When the user exits CPRS or changes patients, CPRS stores
which column the user sorted by and sorts by that column again when the Patient
Selection/Notifications screen is next displayed. By default, after the user
changes patients or enters CPRS again, the column that is saved will sort in
ascending alphabetical order (A-Z) except for the Date/Time column that will
sort by most recent date/time to oldest.
Sorting Notification Columns Using the Mouse
To sort Notifications using the mouse, click the column
heading you want to sort by. To reverse the sort order, click the same heading
again. For example, a user could decide to sort by date and time. Normally, the
most recent alerts are listed first. The user could click the column heading to
reverse the order and have the oldest alerts displayed first. Clicking the
column heading again would list the most recent alerts first.
Sorting Notifications Using the Keyboard
Users who do not use the mouse can sort Notifications in
ascending order (alphabetical order or most recent Date/Time) using the
keyboard only. When users sort using the Ctrl + <key> combination, CPRS
will recognize either upper or lowercase letters (this feature is not
case-sensitive). Users can sort Notifications using the following Ctrl +
<key> combinations:
|
Key Combination
|
Column Sorted
|
|
Ctrl + I
|
Info
|
|
Ctrl + P
|
Patient
|
|
Ctrl + L
|
Location
|
|
Ctrl + U
|
Urgency
|
|
Ctrl + D
|
Alert Date/Time
|
|
Ctrl + M
|
Message
|
|
Ctrl + F
|
Forwarded By/When
|
Note: A
limitation exists in the programming environment that does not allow the user
to user the same key combination to then reverse the sort. Making this change
would not be trivial and will not be addressed the CPRS GUI at this time.
Viewing Comments for Forwarded Alerts
Users may also want to view comments associated with
forwarded alerts. To view a comment, simply place the cursor over the alert,
leave it still for a few seconds, and the comment will display. Move the mouse
and the comment will no longer be displayed.
To bring up the forwarded comment in a separate dialog,
highlight the notification with the comment and select the Show Comment button.
CPRS will display a dialog similar to the one shown below:
When the user
clicks the Show Comment button for a notification that has a forwarded comment,
the comment shows in a dialog.
Note: If the provider has an
NPI, it will not display on the “Forwarded by” screen.
Processing, Removing, and Forwarding Notifications
CPRS provides you with flexibility in processing, removing,
and forwarding Notifications. First, you select the alerts that you want to act
on and then click the appropriate button. For processing notifications, you
have three choices: Process Info, Process All, and Process, which will process
those notifications that you have highlighted. When you are processing
notifications, you can also renew a notification, which ensures that you will
see the notification again the next time you log in, or you can forward the
notification to one or more users.
Note: Sometimes CPRS
will display an alert that belongs to a sensitive record— one that the user
cannot view. CPRS blocks access to sensitive records when the user is
processing notifications and alerts. If the alert that cannot be viewed is the
first one to be processed, CPRS will give an error message and return to the
Patient Selection screen. If the sensitive record is for an alert other than
the first, CPRS will process the alerts until it gets to the sensitive record
and will then return the user to the Patient Selection screen. Then the user
can reselect alerts, excluding the one to the sensitive record, and continue
processing.
Processed alerts are listed on the
Processed tab in the Patient Selection dialog.
You have these options for displaying processed alerts:
● You can specify the date range for the alerts.
● You can limit the number of alerts in the table.
Example of the
Processed alerts tab in the Patient Selection dialog
To process
notifications, use these steps:
1.
Bring up the Patient
Selection screen, either by launching CPRS or if you are already running CPRS,
selecting File | Select New Patient.
2.
Decide which
notifications to process.
•
To process all
information notifications (items preceded by an I.), click Process Info.
•
To process all
notifications, select Process All.
•
To process specific
notifications, highlight one or more notifications, and then select Process. You can also process a
notification by double clicking on it.
Note: To select a number of notifications in a row, click the first
item, hold down the Shift key, and click the last item. All items in the range
will be selected. To select multiple items that are not in a row, click one,
hold down the Control key, and click the other specific notifications.
3.
Process the
notification by completing the necessary task, such as signing an overdue order
or viewing information notifications.
Note: For Audio Renewal requests that cannot be automatically
renewed for some reason, CPRS has a new notification. The Nonrenewable RX
Request for notification is an action alert that takes the user to the orders
tab. The user can then use the Copy to New Order feature (because the order
cannot be renewed) if they want to continue the medication therapy for the
patient. If providers receive an alert for a patient they no longer see, they
can Forward the alert to the appropriate provider. Who receives the alert is
based on the set up for the alert. Contact your CAC or similar personnel if you
are repeatedly getting alerts for the wrong patients.If you want to renew or
forward this notification to someone else, right click the Next button and
select either Renew or Forward as shown in the graphic below. If you selected
Forward, proceed to step 5. If you selected Renew, go to step 6.
This above graphic shows the pop-up menu items available by
right-clicking the Next button
4.
Select the individuals
that you want to receive this notification.
Note: If the provider has an NPI, it will display on the screen
below. See the “National Provider
Identifier (NPI) Display in CPRS” section for an example of an NPI displaying
on a screen.
The Forward
Alert dialog
a.
In the field labeled
Select or enter name, type the first few letters of the person’s last name.
b.
Find the person’s name
in the list and click it to add it to the list of recipients.
c.
Repeat steps a and b
until all those you want to forward this notification to are listed under
Currently selected recipients.
d.
Type a comment if
needed (comment length is limited to 180 characters including spaces).
e.
Click OK.
5.
When finished with the
current Notification, go to the next notification by clicking the Next button
on the status bar.
6.
Process the remaining
notifications using steps 3-5.
7.
When finished, you may
select a new patient (File | Select New Patient…) or exit CPRS (File | Exit).
To
specify the date range for processed notifications, and the maximum number of
processed alerts to display, use these steps:
- You can specify the date range and maximum number by clicking on
either the Tools – Options tab or the Processed tab in the Patient
Selection dialog:
●
If you click the Tools
– Options tab:
i. On the Notifications tab, click the Processed Alerts
Settings button.
ii. On the Processed Alerts Preferences screen, enter a value
in the Show Log Data for (days)
and/or Max # of records to show
field and click OK.
Note: To set the values to the
defaults, click the Defaults button.
iii. Click OK on the
Notifications tab.
Processed Alerts Preferences screen
● If you click the Processed tab in the Patient Selection
dialog:
i. If you want to edit the date range, click the Date Range
button:
1.
On the Range Selector screen,
select a value from the Start and/or Stop Date dropdown and click OK.
To set the values back to the defaults, click the Reset button.
ii. If you want to change the maximum number of alerts that
will display on the Processed tab, click the Max # of Alerts button:
1.
On the Processed Alerts
Preferences screen, enter a value in the Enter Max # of Alerts to Review field
and click OK.
Date
Range and Max # of Alerts buttons on the Processed tab
To
remove notifications, use these steps:
1.
Bring up the Patient
Selection screen, either by launching CPRS or if you are already running CPRS,
selecting File | Select New Patient.
2.
Highlight the
notifications that you want to remove.
Note: To select a number of notifications in a row, click the first
item, hold down the Shift key, and click the last item. All items in the range
will be selected. To select multiple items that are not in a row, click one,
hold down the Control key, and click the other specific notifications.
Warning: Once you remove these notifications you cannot get them
back. Be careful that you really want to remove or delete these notifications
before you proceed.
3.
Click Remove.
Note: A new parameter ORB REMOVE enables sites to specify which
notifications can be removed in this way. If the notification is not removed,
you will have to process the notification.
To forward a
notification to another user, use these steps:
1.
Bring up the Patient
Selection screen, either by launching CPRS or if you are already running CPRS,
selecting File | Select New Patient.
2.
Highlight the
notifications that you want to forward and click Forward.
Note: To select a number of notifications in a row, click the first
item, hold down the Shift key, and click the last item. All items in the range
will be selected. To select multiple items that are not in a row, click one,
hold down the Control key, and click the other specific notifications.When the
dialog shown below displays for each notification, select the recipients’ names
for this notification.
Note: If the provider has an NPI, it will display on the screen
below. See the "National Provider
Identifier (NPI) Display in CPRS" section for an example of an NPI
displaying on a screen.
3.
In the field labeled
Select or enter name, type the first few letters of the person’s last name.
4.
Find the person’s name
in the list and click it to add it to the list of recipients.
5.
Repeat steps 4 and 5
until all those you want to forward this notification to are listed under
Currently selected recipients.
6.
Type a comment if
needed (comment length is limited to 180 characters including spaces).
7.
Select OK.
Repeat the above steps as necessary for additional
notifications you want to forward.
Refreshing a Patient Record
You can refresh a patient’s information so that recent
changes will be reflected. To refresh a patient’s record, select File | Refresh Patient Information.
This option will refresh the information of the currently selected patient in
the same manner that changing patients looks for the latest information.
Refreshing a patient’s information will result in notes in progress being
saved, and the review/sign changes screen will appear if changes are pending.
If the user has opened the chart and changed the patient’s
location (from an inpatient location to an outpatient location or vice versa),
but has not written any orders, the following dialog will appear when the user
selects File | Refresh Patient Information to enable the user to select where
orders should be processed that are written later:
This
dialog appears after a refresh when the patient’s location has been changed,
but no orders have been written yet. The reason for this is that sometimes it
can be difficult to make sure the patient’s location is correct when the
location has changed
CPRS Write Access Functionality
CPRS Write Access functionality enables an authorized VistA
user to permit or restrict write access for each CPRS tab (Problems, Meds,
Orders, Notes, Consults, Surgery and Discharge Summary), and for specific
functionality within each tab (for example, Cover Sheet Vitals, Encounters and
specific Ordering Display Groups). The VistA user can permit or restrict write
access at the System, Division or User level.
CPRS Write Access functionality eases the transition from
CPRS/VistA to the new Electronic Health Record (EHR) system. It ensures continuity of patient care and
optimizes validation of data displayed in the new EHR. Write Access functionality exists because
Sites transitioning to the new EHR must limit unauthorized write-access in CPRS
and Vista. However, sites not moving
over immediately to the new EHR can still restrict Write Access to specific
areas of CPRS for individual users or divisions. There is no impact to downstream systems or
other applications.
Note: If
the Write Access settings have changed in VistA, the CPRS GUI must be restarted
before those updates will take effect.
Note: Instructions
on how to change the CPRS Write Access settings are in the CPRS List Manager
Technical Manual.
To view the Write
Access Permissions, do the following:
- Click on either the Help menu or the New EHR banner (see COVID-19 Identifier/New EHR Banner section):
- If you clicked on the Help menu, click on Write Access Permissions. You
will then see the Write Access Permissions screen.
- If you clicked on the New EHR Banner, you
will see a screen that displays information about write access
permissions. It may also include
localized content about the new EHR cutover.
The Write Access Permission screen
lists the tabs and additional functionality where write access is allowed. If there is a ‘Missing write access
dependencies’ section, it lists write access permission that has been requested
in VistA, but has not been granted because one or more dependencies are
missing. For example, setting Delayed
Orders write access to Yes is only valid when the user has write access to the
Orders tab.
Example of the Write Access
Permissions screen
Example of the screen that displays after you click the New EHR banner
Listed below are examples of the differences between Write Access Allowed and
Write Access Restricted for several tabs.
When the Problem Tab permission is
set to Yes in VistA, the New Problem action is enabled and the user can edit,
inactivate, remove, annotate, or restore a Problem in CPRS. When the Problem
Tab permission is set to No in VistA, the New Problem action is disabled and
the user cannot edit, inactivate, remove, annotate, or restore a Problem in
CPRS.
Example of the Problem Tab
Permissions
(On the Left screen, Problem Tab = Yes, On the Right, Problem Tab = No)
When the Meds Tab permission is set to Yes, the user can
access the functions on the Meds tab.
When the Meds Tab permission is set to No, the Action menu option is
grayed out/disabled.
Example of the Meds Tab Permissions
(On the Left screen, Meds Tab = Yes, On the Right, Meds Tab = No)
When the Orders Tab permission is set to Yes, the user can
create or modify orders. When the Orders
Tab permission is set to No, the user can’t create or modify orders.
Example of the Orders Tab Permissions
(On the Left screen, Orders tab = Yes, on the Right, Orders Tab = No)
When Reminder editor permission is set to Yes, the user can
perform full functions for the Reminder list. The arrows and the OK and Apply
functions are enabled. When Reminder editor permission is set to No, the user
can’t add available Reminders to the Reminder list panel on the right
side. The arrows and the OK and Apply
functions are disabled.
Example of the Reminder Editor Permissions
(On the Left screen, Reminders = Yes, on the Right, Reminders = No)
In the following example, write-access permission for the Orders Tab was set to
Yes, but the Unit Dose Medications write-access was set to No in VistA.
Example of a user who does not have write-access to a some functionality
within the Orders tab
Keeping Diagnostic and Procedure Codes Current
Code set versioning (CSV) modifies VistA to comply with the
Health Insurance Portability and Accessibility Act (HIPAA) stipulations that
diagnostic and procedure codes used for billing purposes must be the codes that
were applicable at the time the service was provided. Because the codes change,
CPRS currently checks ICD and CPT code validity as of a specified date when
codes are entered, when a new code set is implemented, and whenever Clinical
Application Coordinators (CACs) or IRM personnel choose to run the option.
CPRS GUI users will see indicators for inactive codes on the
Cover Sheet, Problems tab, Encounter form, and in Clinical Reminders (although
the Clinical Reminders changes may be less apparent).
In these GUI locations, any diagnosis or procedure codes
that are inactive or will become inactive by a specified date because a new
code set has been installed display with the “#” symbol in front of them as
shown in the following examples.
Cover Sheet Displays
On the Cover Sheet, the active problems display. Users can
quickly see if the patient has any inactive codes for the active problems.
The
‘#’ symbol shows the user that this active problem has an inactive code
If the user tries to get a
detailed display of the problem, the user first gets a warning about the
inactive code.
This
warning message informs the user that the current problem has an inactive code
The warning
message instructs the user to correct the inactive code from the Problems tab.
When the user closes the warning dialog, the detailed display then comes up.
The detailed display also shows that the code is inactive.
The
detailed display of the problem clearly shows that the associated code is
inactive
Encounter Form Display
The Diagnoses tab of the Encounter dialog displays a “#”
next to the code if the code is inactive.
This
screen shows the inactive code with the “#” or pound symbol
If the user tries to select that diagnosis the following
warning appears.
The
warning in this dialog tells users about inactive codes that need to be updated
through the Problems tab
Consults Tab Display
For Consults and Procedures, only active codes will be
allowed for the following functions:
•
Lexicon look up for
provisional diagnosis as of the ordering date
•
Changing existing
orders (the consult or procedure will not be accepted until a valid code is
selected)
•
Edit/Resubmit, the
original code will be checked to see if it is active, if it is inactive an
active code will need to be entered before CPRS will accept it
Clinical Reminders
CPRS GUI will only display codes that were active in the
reminder date range.
CPRS Time Out
If a program has a time out and it is idle for a specific
amount of time, it will be closed. A time out ensures that a record can be
accessed by others who might need it if someone has opened the record, but is
not using it.
IRM can set a different time out or idle value for CPRS
(such as 10 minutes) through a CPRS GUI parameter. If CPRS is open but not used
for the time specified in the parameter, CPRS will display the dialog informing
you that it is going to close in the number of seconds IRM set, count down to
zero, and then close.
•
To keep CPRS running,
select Don't Close CPRS.
•
To close CPRS
immediately, select Close CPRS.
If only one CPRS session is open, the dialog looks like
this:
If multiple sessions are open, the
dialog looks like this, including the identification of which session is about
to close:
Because CPRS makes the session that is about to close
active, users need to make sure they are in the correct chart after the user
responds to this dialog.
Features Available from Any Tab
There are several items located at the top of the CPRS
window that are available from any tab. These items are:
● the CCOW icon
● the Patient Inquiry button
● the Encounter Provider and Location button
● the Primary Care button
● the Patient Insurance/My HealtheVet button (which is hidden
if the patient has no insurance nor My HealtheVet information)
● the Flag button
● the Vista Web button, the Remote Data button
● the Reminders button
● the Postings button
Note: When a user
resizes the CPRS window enough, the buttons can be hidden although they are
still there. To ensure that users can still get to the information that these
buttons provide, an Information menu item was added to the View menu. This item
enables users to access the information from these buttons, even if the buttons
are not visible because of screen size.
A detailed
explanation of each of these buttons is included below.
Items
available from any CPRS tab
Clinical
Context Management (CCOW) Icon
Clinical Context Management (sometimes referred to as
“CCOW”) is a way for graphical user interface (GUI) applications to synchronize
their clinical context based on the Health Level 7 CCOW standard. In simple
terms, this means that if CCOW-compliant applications are sharing context and
one of the applications changes to a different patient, the other applications
will change to that patient as well.
The VA purchased Sentillion’s Vergence context management
software to work with VistA.
To use the CCOW standard, VistA set up must include these
two components:
•
a context vault, which
is a server on the VA LAN that tracks context for each clinical workstation
•
desktop components
installed on each workstation that will use CCOW
To allow VistA GUI applications to use context management,
the developers must make the necessary changes to HL7 messages for each
application to allow synchronization. Current plans call for the following
applications to be CCOW compliant:
•
CPRS *
•
HealtheVet Desktop (Care Management) *
•
Imaging *
•
Clinical Procedures
•
BCMA (Bar Code
Medication Administration)
•
Vitals
•
FIM (Functional
Independence Measure)
•
Scheduling
* These applications
will be made CCOW compliant first.
CPRS has been made CCOW-compliant and can now synchronize
with other VistA CCOW-compliant applications. The first three applications that
will be CCOW compliant are CPRS, Care Management, and Imaging. Care Management
provides one example of applications synchronization. If you were in Care
Management, which is also CCOW-compliant, and clicked the CPRS Chart link, the
CPRS GUI chart would be launched and would bring up the same patient that had
focus in Care Management. You can also have two CPRS sessions synchronized.
And, of course, you can bring up two different CPRS sessions and not
synchronize them, thus allowing you to view two patients’ charts at the same
time.
The CCOW icon shows whether the current application is
linked with others on the desktop.
The
above graphic shows the CCOW icon in outlined in red at the far left of the
chart
CPRS enables users to join or
break context with other applications. The icon displays whether CPRS is joined
in context or not. The following three icons will display based on the CCOW
state:
Linked
Broken
Changing
Note: There are a few cases when you cannot change
context, such as when a print dialog is open or when you are trying to open an
application from the Tools menu. If you try to change context with unsigned
orders or notes, the following dialog will display.
This
graphic shows what a warning message might look like
If
the application is busy doing something and cannot change context, CPRS will
display a message such as the one above
To join context, use the following steps:
Note: If a
context error occurs, the Rejoin patient link menu item will not be available
for the rest of the current CPRS session. It will be available again when the
user closes CPRS and then launches CPRS again.
1.
Give focus to the
application that you want to join context by either clicking on that
application window or by holding down the Alt key and pressing tab until you
highlight the appropriate application and then release the keys.
2.
Choose File | Rejoin
patient link.
3.
If you want the other
open applications to synchronize with the current patient in the application
that has focus, choose Set new context.
Or, if you want the current application to synchronize with the patient the
other applications have open, choose Use
Existing Context.
To break context between applications, follow these steps:
Note: If a context error occurs, the Rejoin patient
link menu item will not be available for the rest of the current CPRS session.
It will be available again when the user closes CPRS and then launches CPRS
again.
1.
Give focus to the
application that you want to remove from context by either clicking on that
application window or by holding down the Alt key and pressing tab until you
highlight the appropriate application and then release the keys.
2.
Choose File | Remove
from link.
Patient
Inquiry Button
The Patient Inquiry button is located on the left side of
the chart directly below the menu bar.
The Patient Inquiry button displays the following information:
•
Patient name
•
Status (inpatient or
outpatient)
•
Social Security number
(or identification number if assigned by the site)
•
Date of birth
•
Age
•
Display Caregiver
information (if available). The primary, secondary, and general caregiver(s)
will display if they are present and considered active.
The
Patient Inquiry button
If the patient’s preferred name has been
entered into VistA, it will display in parentheses after the patient’s first
name on the Patient Inquiry button, as shown below:
Patient Inquiry button for a patient with a preferred name
If you select the Patient
Inquiry button, the Patient Inquiry dialog appears. The Patient Inquiry
dialog includes additional information such as the patient’s mailing address,
telephone numbers (including the patient’s home, work, and cell phone numbers),
admission information, and other relevant data, such as provider information
(including the patient’s mental health treatment coordinator (MHTC) contact
information, displaying in two locations on the Patient Inquiry form) and
primary and secondary next-of-kin entries. Caregiver information also displays (if available)—this
includes the primary, secondary, and general caregiver(s) if they are present
and considered active.
The Mental Health Treatment Coordinator
is the liaison between the patient and the mental health system at a VA site.
There is only one MHTC per patient, and the MHTC is the key coordinator for
behavioral health services care. While in the detailed display, you can select
a new patient, print the detailed display, or close the detailed display.
Patient Inquiry Dialog Example
Patient Inquiry Dialog
Example (continued)
The
Patient Inquiry dialog also shows information that can be printed including
demographic information, Permanent & Total Disabled status, and Health
Benefit Plans currently assigned to the Veteran.
If a patient’s
preferred name has been entered into VistA, it will display in parentheses next
to the patient’s first name, as shown below:
Patient
Inquiry screen for a Patient with a Preferred Name
The preferred name will display only on the Patient Inquiry button
and screen. It will not display on any
other CPRS GUI screen or report.
Encounter Information
CPRS has two kinds of encounter information: visit
information and encounter form data. Encounter form data is explained later in
this manual.
For each visit (or telephone call) with a patient, you must
enter the provider, location, date, and time. CPRS requires this information
before you can place orders, write notes, add to the problem list, and perform
other activities.
To receive workload credit, you must enter the encounter
form data, including the following information, for each encounter:
•
Service connection
•
Provider name
•
Location
•
Date
•
Diagnosis
•
Procedure
Visit / Encounter Information
CPRS shows the encounter provider and location for the visit
on the Visit Encounter button. You can access this feature from any chart tab.
The
Visit Encounter button
Entering Encounter Provider and Location
If an encounter provider or location has not been assigned,
CPRS will prompt you for this information when you try to enter progress notes,
create orders, and perform other tasks.
To enter or change the Encounter provider, follow these
steps:
1.
If you are already in
the Provider & Location for Current Activities dialog skip to step 2.
Otherwise, from any chart tab, click the Provider
/ Encounter box located in the top center portion of the dialog.
Note: These instructions are written as if the user must select a
provider. If the user making the selection is a provider, the user will be
selected by default and the cursor will go to the New Visit tab if no visit is
defined, or to the Clinic Appointments tab if one is defined. If the user is
not a provider, the cursor will go to the Encounter Provider field so that the
user can select the provider for the encounter.
2.
In the Encounter
Provider list box, locate and select the provider for this encounter.
Note: To help you distinguish between providers, CPRS displays
their titles (if available). When two or more providers have identical names,
CPRS also displays:
o The service/section and
site division (if any) associated with these providers; site divisions are
displayed based on the following rules:
□
When no division is
listed for a provider, no division is displayed.
□
If only one division
is listed, this division is displayed.
□
If the site has
multiple divisions or more than one division is listed and one of these listed divisions is marked as Default, CPRS
displays the division marked as Default.
□
If more than one
division is listed for a provider and none is marked as Default, CPRS does not
display division information for this provider.
o Providers who are listed
in the New Person file as Visitors are screened out from the provider list.
(These screened-out providers are listed as Visitors because their entries were
created as a result of a Remote Data View.)
3.
Select the tab that
corresponds to the appropriate encounter category (Clinic Appointments,
Hospital Admissions or New Visit.) Select a location for the visit from the
choices in the list box.
4.
If you selected a
clinic appointment or hospital admission, skip to step 7. If you are creating a
New Visit, enter the date and time of the visit (the default is NOW).
5.
Select a visit
category from the available options (such as, Historical) and select OK.
6.
When you have selected
the correct encounter provider and location, select OK. If
the Similar Providers screen appears, select a provider from the list and
select OK.
Note: If the last name and the first
two letters of the first name match another provider, CPRS will display
the Similar Providers screen, which will prompt the user to select the
right provider from a list of providers with similar names, as shown in
the screenshot below. This functionality exists in thirty-seven areas of CPRS
but it always works the same way.
Similar Providers screen
7.
For more information
and instructions on entering more encounter form data, refer to the Notes
section of this manual.
Primary Care
Information
Improvements are coming to the display of provider and team
information that users see on the Primary Care button and in the detailed
display that the user can view by selecting the Primary Care button. This
section will show the display as it currently is and how it will look after
patch OR*3.0*387 (also referred to as PCMM Web) is full deployed. The patch
deployment will be phased and may take up to a year.
When patch OR*3.0*387 is installed,
users will immediately see changes in the Primary Care detailed display. Any
changes to the items on the Primary Care button itself will be included in a
later version of CPRS.
Current Display (CPRS v.30.b before OR*3.0*387)
To the immediate right of the Visit Encounter button is the
Primary Care button on which, for an inpatient, CPRS displays might display as
many as six items of information if all are assigned to this patient:
•
the Primary Care
Management Module (PCMM) or primary care team (outpatient team)
•
primary care provider
or PCP (outpatient provider)
•
the associate provider
(outpatient provider)
•
the (Inpatient)
attending provider
•
the (Inpatient)
provider
•
the mental health
treatment coordinator (for both an inpatient or an outpatient)
Definitions of different providers:
•
A Primary Care
Provider (PCP) provides care to a patient at the time of first– non-emergent
contact, which occurs on an outpatient basis.
•
An Associate Provider
is usually the Resident working with a patient’s PCP, and is providing outpatient primary care. (A Resident is a graduate and licensed
physician receiving training in a specialty.)
•
An Attending
Physician/Admitting Provider is the physician with primary responsibility for
the care of a patient who is admitted to the hospital.
•
An Inpatient Provider
is the Resident providing inpatient primary care.
•
A Mental Health
Treatment Coordinator (MHTC) is the person who is designated to coordinator a
patient’s mental health needs.
Possible Providers for Inpatients
The items are arranged on the button as shown below in the
diagram and then on the button itself:
<PCMM
Team> / PCP: <name> /
Associate PCP: <name>
Inpatient
Attending: <name> / Provider: <name>
This
screen capture shows the Primary Care button for an inpatient with all the team
items displayed and where they are displayed on the button. The first row has
three possible items: the PCMM team, the Primary Care Provider, and the
Associate Primary Care Provider. The second line has the inpatient provider
information: Inpatient Attending or Admitting provider and the Inpatient
Provider. The third line displays the Mental Health Treatment Coordinator
The
Primary Care button for an inpatient with the primary care team, primary care
provider, associate provider, attending physician, and mental health treatment
coordinator showing
Possible Providers for Outpatients
For outpatients, CPRS might display up to four items:
•
the PCMM or primary
care team (for an outpatient)
•
primary care provider
(for an outpatient)
•
the associate provider
(for an outpatient)
•
the mental health
treatment coordinator (for both an inpatient or an outpatient)
The items are arranged on the button as shown below in the
diagram and then on the button itself:
<PCMM
Team> / PCP: <name>
/ Associate PCP: <name>
MH
Treatment Coordinator: <name>
This
screen capture shows how the Primary Care button would look for an outpatient
if all team items are assigned. In the first row, CPRS displays the PCMM or
primary care team, the primary care provider, and the associate primary care
provider. The second row displays the mental health treatment coordinator
The Primary Care button as shown for
an outpatient with the primary care team, primary care provider, and mental
health treatment coordinator
Primary Care Dialog’s Assigned Providers Contact Information
When the user selects this button, CPRS displays a dialog
containing the contact information for the above providers and the mental
health treatment coordinator.
Only the information
that is available to CPRS is displayed. If the various providers have not been
entered, only what has been entered will display. The message “Primary Care
Team Unassigned” is displayed if a primary care team has not been
assigned.
For more information on the providers listed on the button,
select the Primary Care button to
display the Primary Care details dialog as shown in the example below.
Note: If the provider has an NPI, it will not
display on the screen below.
The Primary Care Display after PCMM Web (OR*3.0*387)
Installation
When the OR*3.0*387 (also known as PCMM Web) is deployed,
you will see changes in the Primary Care detailed display.
Information on the Primary Care Button
It is anticipated that there will be changes to the
information displayed on the Primary Care button with the release of CPRS GUI
v31b.
Information in the Primary Care Detailed Display
The changes to the Primary Care detailed display provide
additional information for users regarding who has seen the patient and giving
contact information for them. Several items have been added to the available
information, such as information from different sites, additional information
about the kinds of providers listed, and new labels for teams, etc.
All active team information will display regardless of
station.
Some items only display if certain conditions are met. For
example, if the patient is not an inpatient, no inpatient information is
displayed. If an associate provider is not explicitly assigned to the patient,
it will not display. If information is not entered for a team, no team
information or labels will display.
Local versus Remote Sites
The detailed display shows whether the information that the
user is viewing is local or remote. The detailed display can show both local
and remote information at the same time. Sites will display in alphabetical
order with all local sites first, then all remote sites, and finally any Non-VA
providers that might be entered.
The format is to show the word “Local” or “Remote,” the site
name, and then the station number as the example below shows:
LOCAL – CHEYENNE (442)
LOCAL – CHEYENNE (442) ||GREELEY CBOC (442GC) [B-03124]
REMOTE – DC VAMC (999)
Non-VA
After each entry such as those above, the team information
will display. The middle item above is an example of how a community-based
outpatient clinic (CBOC) displays.
A site is labeled as remote if the first three numbers of
the station are different from the first three of the station where the user is
logged in. Local information is shown first followed by remote information.
Inpatient Information
If the patient is not an inpatient, the inpatient
information will not display. Inpatient information displays in the following
format:
•
Inpatient Attending:
Name, Phone #, Pager
•
Inpatient Provider:
Name, Phone #, Pager
Team Information
Team information will display under each heading if the
information is available. Team information is displayed below the team name.
Optional information in the examples is shown in formatting
surrounded by curved braces {}. Phone numbers will display if they are entered
into PCMM.
There are five kinds of teams. Each
is labeled as shown below and they are displayed in this order with local teams
first and remote teams after:
PACT: for Primary Care
MH: for Mental Health
OEF/OIF/OND: for Operation Enduring Freedom/Operation Iraqi
Freedom/ Operation New Dawn
SP: for Specialty Team
Non-VA: for Non-VA Provider
Primary Care Team Information
Primary Care Team information for an outpatient could
include the following:
•
Primary Care Provider:
PCP Name, PCP Phone, Pager
•
Associate Provider: AP
Name, AP Phone, Pager
•
Administrative POC:
Team Role, Admin POC Name, Admin POC Phone, Pager
•
Clinical POC: Team
Role, Clinical POC Name, Clinical POC Phone, Pager
Note: The Associate
Provider will only display if one is explicitly assigned to the patient. If
not, it will not display.
There are several messages that can display if information
is missing. Here are a few items to consider:
•
No PACT assigned at any VA location: displays if the patient does not have an active PACT team
assignment at any station
•
PACT: No Local PACT Assigned: displays if the patient does not have an active PACT team
assignment at the local station
•
PENDING (before a team
name): displays if the team has been assigned but the patient has not seen a
member of the team yet
Mental Health Treatment Team Information
The Mental Health Treatment team information displays the
following:
MH: MH Treatment Team Name
MHTC: MH Treatment Role Name, MH Treatment Coordinator Name,
Phone, Pager
Note: Any additional Mental Health teams will be
displayed here.
OEF/OIF/OND Team Information
OEF/OIF/OND: [OEF/OIF/OND Team Name Lead Coordinator Name, LC phone, Pager
Note: Any additional OEF/OIF/OND teams will be
displayed here.
Specialty Team Information
SP: Specialty Team Name
Team Role Name, Team Member XXX Name, Phone, Pager
Note: Any additional Specialty teams will be
displayed here.
Non-VA Provider Information
Non-VA Role, Specialty Name, Non-VA Provider Name, Phone,
City, State
Note:
Any additional Non-VA Providers will be
displayed here.
Example Detailed Display Formats
PRIMARY CARE
LOCAL – Station Name (#) or
LOCAL – VAMC Station Name (#) || Station
Name (#)
{
Inpatient Attending: [Name]||PHONE:
[Phone #]||PAGER: [Pager]
Inpatient Provider: [Name]||PHONE: [Phone #]||PAGER: [Pager] }
PACT: {PENDING:} [Primary Care Team
Name]
Primary Care Provider: [PCP Name]||PHONE:
[PCP Phone]||PAGER:
[Pager]}
Associate Provider: [AP Name]||PHONE:
[AP Phone]||PAGER: [Pager]
Administrative POC: [Team Role]||[Admin
POC Name]||PHONE: [Admin POC
Phone]||PAGER: [Pager]
Clinical POC: [Team Role]||[Clinical POC
Name]||PHONE: [Clinical POC Phone]||PAGER: [Pager]
{LOCAL or REMOTE – Station Name
(#)}
MH: MH Treatment Team Name]
(MHTC) [MH Treatment Role Name]||[MH
Treatment Coordinator
Name]||PHONE: [Phone]||PAGER: [Pager]
{LOCAL or REMOTE – Station Name
(#)}
OEF/OIF/OND: [OEF/OIF/OND Team Name]
LEAD COORDINATOR: [Lead Coordinator
Name]||PHONE: [Phone]||PAGER: [Pager]
{LOCAL or REMOTE – Station Name
(#)}
SP: [Specialty Team Name]
[Team Role Name]||[ Team Member XXX
Name]||PHONE: [Phone]||PAGER: [Pager]
Non-VA: [Non-VA Role||Specialty
Name]||[Provider Name]||PHONE: [Phone]||[City], [ST]
Note: If the
provider has an NPI, it will not display on the screen above.
Other than Honorable (OTH)
To help
address veterans with high risk for suicide, the VA
provides two types of eligibility for former servicemembers with Other than
Honorable (OTH) discharge types seeking mental health care:
● OTH-90
care type - Provides one or more 90-day episodes of care within a 365-day
period for those who have an OTH discharge.
● OTH-EXT
care type - Provides care with no time limit for those who have an OTH
discharge.
Note: The OTH buttons will display only if
patches DG*5.3*952 and DG*5.3*977 are installed and the necessary criteria are
met. If the patches are not installed, the OTH button will not display.
The OTH-EXT care type will display in the OTH
button only if patch DG*5.3*977 is installed.
When the OTH veteran is
enrolled, he or she is given a primary eligibility code that enables the
veteran to receive care, but this eligibility will be adjudicated by the
Veteran’s Benefits Association (VBA). This OTH eligibility provides two types
of OTH care: OTH-90 or OTH-EXT. The OTH button displays either “OTH” or
“OTH-EXT” values until VBA changes the eligibility code, then it will no longer
display.
For patients meeting the
criteria, the OTH button displays between the team information button and the
Flag button on the strip available from any tab as shown in the screen captures
below.
On the OTH button, the label
‘OTH’ displays, along with how many days remain in the period of care and which
period of care the patient is in. So, it will be a number followed by the
letter “D” for the number of days and then a “P” followed the number of the
current period of care.
The OTH 90 button shown in the
example above, shows ‘36D’ meaning 36 days left in the first 90-day period of
care (or ‘P1’).
When the user selects the OTH
button, a popup window dialog box displays the same information that displays
on the button including additional information.
Note: Number of
days will not display on the OTH Button label when the patient has an inactive
flag. The image below is an example of an OTH-90 patient with an Inactive Flag
history.
Note:
Patch OR*3.0*546 introduces the ability to add a local message for OTH-90
patients. Messages are entered in VistA (Graphical User Interface (GUI)
Parameters menu option) by Clinical Care Coordinators and are displayed in
CPRS. The figure below is an example of the OTH-90 pop-up window with a local
message.
To display the OTH popup window dialog
box:
- Select the OTH button.
- After viewing the
information, close the dialog by selecting the “OK” button.
Note: A tooltip provides detailed information.
● If
the user hovers the cursor over the ‘OTH’ label on the button, “Other Than
Honorable, click for details” will be displayed.
● If
the user hovers the cursor over the button with an example text of “54D, P1”,
the tooltip will display “54 day(s) remaining in the current period”.
● If
the user hovers the cursor over any white area (non-text area) on the button,
“Other Than Honorable, click for details 54 day(s) remaining in the current
period” will be displayed.
The OTH-EXT button shows that the “OTH-EXT” care type is
assigned to the patient.
When the user selects the OTH-EXT button, a dialog displays
additional information.
Note: Patch OR*3.0*546 amended verbiage
to include more information about Military Sexual Trauma (MST).
To display the
OTH-EXT popup window dialog box:
- Select the OTH-EXT button.
- After
viewing the information, close the dialog by selecting the “OK” button.
Note: A tooltip provides detailed information.
● If
the user hovers the mouse over the ‘OTH-EXT’ label on the button “Other Than
Honorable, click for details” will be displayed.
Patient Insurance and MyHealtheVet Information
The Patient Insurance and My HealtheVet information are available from the button to the right of the
Primary Care button. This button displays only if the patient’s insurance
information has been entered or if the patient has entered information through
My HealtheVet. If the patient does not have either of these types of
information the button does not display.
The
Patient Insurance and My HealtheVet
button is visible only when the patient has one of these kinds of information.
It is located next to the Flag button
When this button does display, it will look different based
on what information the patient has. If the patient has only patient insurance
information, the button will read
“Pt Insur” and clicking the button will bring up a detailed
display containing the insurance information.
If the patient has only My HealtheVet information, the button displays “MHV” and clicking the button
will bring up a browser windows with the patient’s information.
If the patient has both patient insurance and My HealtheVet information, the button will appear
to be split in half vertically. The top button will read “MHV” and the bottom
will read “Pt Insur” The buttons work the same as if they were full size.
Presumptive Psychosis
Presumptive Psychosis (PP) patients are registered as
Service Connected (less than 50%) Veterans with an Honorable or General
discharge and who meet other PP workaround criteria. To identify these patients
a PP button will display using the same real estate as the OTH button (left of
the Flag button).
Note: The PP
button will display only if patches DG*5.3*1029 and OR*3.0*437 are installed and the necessary criteria are met. If
the patches are not installed, the PP button will not display.
Example
of PP Button Location
When hovering over PP, the following text displays:
Presumptive Psychosis Authority, click for details.
When hovering over the second row (i.e. Rej), the following
text displays: Rejected due to income.
The image below is an example of the PP Patient Chart.
Example
of PP Patient Chart
Follow the instructions below to open and view Patient
Chart:
- Look up patient
- Navigate to PP button
- Click
on PP button to open and view Patient Chart
Prescription Drug-Monitoring Program (PDMP)
Authorized users (licensed prescribers and pharmacists) and
delegates are able to access the PDMP query functionality.
The Prescription Drug-Monitoring Program (PDMP) enhancement
to CPRS allows authorized users (prescribers and pharmacists) and licensed
delegates to submit on demand PDMP queries for use in patient care related
decision making when prescribing controlled substances to Veterans. The process
allows the user to:
●
View and retrieve
controlled substance prescription monitoring data from external sources
and within patients electronic medical
records
●
Automatically generate
patient progress notes
●
Query and easily
utilize prescription and patient prescription history on an ad-hoc and
recurring basis
●
Perform audit
functions that ensure compliance.
CPRS
Cover Sheet displaying the PDMP Query Button
Note:
Hover over (put your cursor over) the PDMP
Query button from the ribbon bar to display the last query completed date.
The completed date is the date when the last STATE PRESCRIPTION DRUG MONITORING
PROGRAM note was signed and completed). If a previous PDMP note was never
completed for this patient, it will display "Last query completed:
Unknown."
Authorized HealthCare Provider Procedure for PDMP
Query
Authorized Prescribers (with a DEA #) and Pharmacists (with
an NPI #) can initiate a PDMP query using their own credentials.
To request a PDMP Query, follow these steps:
1.
From the ribbon bar,
click on the PDMP Query button, it
will change to PDMP Cancel. The
query will run in the background, and the user can continue to work in CPRS
while the query is running. After a few seconds, the PDMP Cancel button will change to PDMP Results.
Note: You can also select PDMP
from the Tools drop-down menu.
PDMP Query - requests the query
PDMP Cancel
- indicates the query is in progress—clicking it cancels the query
Note: Retrieving the results
may take a while as the query searches all 50 states' databases (through a
third party PDMP gateway). This process is outside of CPRS’s control.
PDMP Results - validates the query
is completed
2.
Click on the PDMP Results button to display the PDMP
report. The Prescription Drug Monitoring
Program Results report displays in a separate window.
Note: If encounter information
has not been entered, the encounter information dialog will appear before the
PDMP report is displayed. You must complete the encounter information dialog
before proceeding.
Note: Retrieving the report
may take a while as it must be retrieved through a third party PDMP gateway.
This process is outside of CPRS’s control.
PDMP Results Report
The report allows the user to
review the PDMP results and to automatically generate a note to document any
findings. It has three sections: Demographics, Summary, and Prescriptions. The
bottom of the report displays the date of the last PDMP Query (which is the same date as the date previously noted in the hover
over Note for the PDMP Query), Four (4) statement
selections, as well as the Cancel
Without Update and Done and Create
Note buttons.
Note: You must select at least
one of the Statements. Clicking the Done and Create Note button without
selecting a Statement, will produce the error message: "At least one
option should be selected."
Provider PDMP Results
Report Statements
Each of
the four (4) Provider Statement selections is described below:
1st Statement
o
No prescription (s) for controlled substances outside the
VA were found in the last 90 days.
o Selecting this statement will produce a text box to enter
comments of up to 250 characters (optional).
2nd Statement
o Prescription(s)
filled outside the VA in the last 90 days are noted. However, they do not raise
significant safety concerns and do not influence the treatment plan at this
time.
o Selecting this statement will produce a text box to enter
comments of up to 250 characters (optional) and the following Non-VA Meds
reminder statement displays below the text box: "Please be sure to record any active/chronic medications discovered from
PDMP query in the Non-VA Medications section of the Meds Tab in CPRS."
3rd Statement
o Prescription(s)
filled outside the VA in the last 90 days are noted. Safety concerns will be
discussed with the patient and documented as part of ongoing treatment
planning.
o Selecting this statement will produce a text box to enter
comments of up to 250 characters (optional) and the following Non-VA Meds
reminder statement displays below the text box: "Please be sure to record any active/chronic medications discovered from
PDMP query in the Non-VA Medications section of the Meds Tab in CPRS."
4th Statement
o Prescription(s)
filled outside the VA are noted and will be addressed as follows:
o Selecting this statement will produce a text box to enter
comments of up to 250 characters (required) and the following Non-VA Meds
reminder statement displays below the text box: "Please be sure to record any active/chronic medications discovered from
PDMP query in the Non-VA Medications section of the Meds Tab in CPRS."
- Click the Done and Create Note button.
A STATE PRESCRIPTION DRUG MONITORING PROGRAM progress note
will automatically be created in the background. Click on the Notes tab at the bottom of the Cover
Sheet to view the Progress Note with today's date.
Note: For a Progress
Note example, refer to Example of a Progress Note at the end of this section.
- Select the PDMP note. From the top menu, select
Action, and click ‘Sign Note Now.' The 'Sign Note Now'
window displays.
Sign Note Now Window
- Enter
the Signature Code for the Provider and click ‘OK.’ The status of the note changes to ‘COMPLETED.’ Electronic
Signature and Date/time stamp displays on the note.
Note: Refer
to 'The Sign Note Now
and Sign Discharge Summary Now Commands'
for 'Sign Note Now' details.
Example of a Provider Progress Note
Delegate Procedure for PDMP Query
If you are registered with the State PMP as a Delegate using
your va.gov email address, you can run a query as a delegate of an authorized
PDMP user.
To request a PDMP Query, follow these steps:
1.
From the ribbon bar,
click on the PDMP Query button.
2.
You will be prompted
to Select Authorized User from the
pop-up dialog. The encounter provider (if they are an authorized PDMP user) is
selected by default.
Select Authorized User
3.
Click Accept. PDMP Query changes to PDMP
Cancel. The query will run in the background, and the user can continue to
work in CPRS while the query is running. After a few seconds, the PDMP Cancel button will change to PDMP Results.
PDMP Cancel - indicates the query
is in progress—clicking it cancels the query
Note: Retrieving the
results may take a while as the query searches all 50 states' databases
(through a third party PDMP gateway). This process is outside of CPRS’s
control.
PDMP Results - validates the query
is completed
4.
Click on the PDMP Results button to display the PDMP
report. The Prescription Drug Monitoring
Program Results report displays in a separate window.
Note: If encounter
information has not been entered, the encounter information dialog will appear
before the PDMP report is displayed. You must complete the encounter
information dialog before proceeding.
Note: Retrieving the
report may take a while as it must be retrieved through a third party PDMP
gateway. This process is outside of CPRS’s control.
PDMP Results Report
The report allows the user to
review the PDMP results and to automatically generate a note to document any
findings. The report has three sections: Demographics, Summary, and
Prescriptions. The bottom of the report displays the date of the last PDMP Query
(which is the same date as the date
previously noted in the hover over Note for the PDMP
Query), Two (2) statement selections, as well as the Cancel Without Update and Done
and Create Note buttons.
Note: You must select
at least one of the Statements, clicking the Done and Create Note button without selecting a Statement, will produce the
error message: "At least one option
should be selected."
Delegate PDMP Results Report Statements
Each of the two (2) Delegate
Statement selections is described below:
1st Statement
o No
prescription(s) for controlled substances outside the VA were found in the last 90
days.
o Selecting this statement will produce a text box to enter
comments of up to 250 characters (optional)
2nd Statement
o
Prescription(s) that have been filled outside the VA in
the last 90 days are noted.
o
Selecting
this statement will produce a text box to enter comments of up to 250
characters (optional) and the following Non-VA Meds reminder statement displays
below the text box: "Please be sure
to record any active/chronic medications discovered from PDMP query in the
Non-VA Medications section of the Meds Tab in CPRS."
- Click the 'Done and Create Note button.' A
STATE PRESCRIPTION DRUG MONITORING PROGRAM progress note will
automatically be created in the background.
Note: For a Progress Note
example, refer to Example of a Progress Note at the end of this section.
Sign Note Now Window
- Enter the Signature Note Code for the Delegate and Click ‘OK.’ The status of the note is
'UNCOSIGNED' and a message displays on the note, "NOT YET
COSIGNED." Signed Date and Time is created with the electronic signature
of the delegate. The note then goes to the cosigner to sign the note.
Note: Refer to 'The Sign Note Now and Sign
Discharge Summary Now Commands' for Sign
Note Now' details.
Example
of a Delegate Progress Note
Accessing a PDMP Button on a
Reminder Dialog Template
Sites have the option of adding a PDMP Button to a Reminder
Dialog Template. This feature is not
required. It enables sites to use their
own Reminder Dialogs template for preparing notes that include data from PDMP
reports. The PDMP button on the Reminder
Dialog Template can be used in addition to, or in place of the PDMP button at
the top right-hand corner of the CPRS window.
To configure the Reminder Dialog Template with a PDMP
button, the site CACs need to add the Reminder Dialog prompt, PXRM PDMP BUTTON,
to the template. It would add a PDMP button to a Reminder Dialog template and
allow users to click on it to initiate a PDMP query.
There are differences between a PDMP query that is initiated
on a reminder dialog template vs when it is initiated from the top of the CPRS
window. When it is initiated from a reminder dialog template:
● The PDMP report will open automatically as soon as it is
available.
● The report is opened as a modeless window, so that the
report and reminder dialog template can be interacted with simultaneously.
● The radio buttons on the bottom of the report will not
display and the ‘STATE PRESCRIPTION DRUG MONITORING PROGRAM note will not
automatically generate. Note: To
ensure that the PDMP query is captured for compliance measurement, the site’s
CAC must ensure that the template is attached to the STATE PRESCRIPTION DRUG
MONITORING PROGRAM note title. The template should contain the necessary field
elements so that the user can record their findings from the report.
● The user may close the report either by selecting the
‘Close’ button, by closing the local reminder dialog template itself, or by
selecting another patient.
Example
of a PDMP button in a Reminder Dialog Template
Example
of a Report Generated by a PDMP Button in a Reminder Dialog Template
PDMP Accounting of Disclosure (AOD) report
A PDMP Health Summary Report, PDMP AOD ALL, was created to
generate a PDMP Accounting of Disclosure (AOD) report. This component lists the
PDMP Accounting of Disclosures for instances where a PDMP query was initiated
from within CPRS and patient's data was shared outside of the VA. It will also
include cases where a PDMP note was manually created to document a PDMP query
made directly on a state's PDMP portal.
Note: For more information, refer to Viewing a Health Summary.
Example
of an Accounting of Disclosure (AOD) report
Patient Record
Flags
Patient Record Flags (PRF) are advisories that authorized
users place on a patient’s chart to improve employee safety and the efficient
delivery of health care. Each advisory or flag includes a narrative that
describes the reason for the flag and may include some suggested actions for
users to take when they encounter the patient. Other information displayed to
the user includes the Flag Type, Flag Category,
Assignment Status, Initial Assignment Date, Approved by,
Next Review Date, Owner Site, and Originating Site. When assigning a flag,
authorized users must write a progress note that clinically justifies each flag
assignment action.
Flags are defined in the PRF List Manager software either
through a patch or by an authorized user. Once the flag definition exists,
authorized users can use the following actions in the PRF software to assign
and maintain the flag on a specific patient’s record: new assignment, continue,
inactivate, mark as entered in error, and reactivate.
To make flags widely available to VHA employees who interact
with patients, Patient Record Flags are tied to the patient look-up. Whenever a
user looks up a patient, the software checks to see if the patient’s record has
been flagged, and if a flag exists, the software displays the list of flag
names.
To ensure that users notice them, CPRS uses a Patient Record
Flags pop-up box. After a user selects a patient with an active flag
assignment, CPRS pops up a dialog containing all flags for the patient. Users
can review the flags or close the box. The rest of the patient record does not
load until the user closes the PRF pop-up box. Once the rest of the record is
loaded, users can view flags at any time using the Flag button or the Cover
Sheet list of PRF displayed on the upper right of the Cover Sheet under Patient
Record Flags.
Sites can help users notice the flags by using Patient
Record Flags judiciously. Overusing these flags could make them cumbersome to
users who might therefore choose to ignore them. Ignoring flags could put
employees, other patients, and the health care environment at risk.
To avoid this situation, before placing a flag on a
patient’s record, sites must have in place a system for deciding when a flag is
appropriate and when it will be reviewed. Sites should also have policies about
how to handle questions about flags. To give sites some direction about
implementing Patient Record Flags, VHA Directive 2010-053, dated December 3,
2010, titled: Patient Record Flags
has been issued.
Category I and Category II Flags
Patient Record Flags are divided into types: Category I
(national) and Category II (local). Category I Patient Record Flags are the
most critical and are transmitted to all facilities, ensuring that these flags
are universally available. Category II Patient Record Flags are local only,
belonging only to the site that created them; they are not shared between
sites.
Category I or National Flags
CPRS has two Category I Patient Record Flags: a Behavioral
flag for violent or potentially violent patients and a High Risk for Suicide
flag. The Office of Information created the Behavioral flag to help VHA
properly protect its employees and maintain a safe environment for health
care–they also now contain information regarding Disruptive Behavior Reporting
System Cases for the patient (‘DBRS number’ and ‘Other DBRS data’). The High
Risk for Suicide flag aims to identify patients who might be at higher risk of
taking their own lives. The Office of Information defines and distributes
Category I flags through national patches and the definition of the flag cannot
be edited by local sites.
Each Category I flag assignment to a specific patient’s
record is owned by a single facility. The facility that placed the Category I
flag on the patient’s record would normally own and maintain the flag. The site
that owns the Category I flag is the only site that can:
•
review whether to
remove or continue the flag
•
edit the flag
•
inactivate the flag
•
reactivate the flag
•
mark the flag as
entered in error
•
change ownership of
the flag
•
Enter/edit DBRS data
(only on a National Category I Behavioral flag)
•
enter a Patient Record
Flag Category I progress note for the flag
However, ownership of a Category I flag assignment can be
transferred. If a patient received the majority of care at a different VA
facility than the one that assigned the flag, the site giving the majority of
care could request that ownership of the flag be transferred to the that site.
The owning site could then change the ownership to the second site through the
PRF software in List Manager.
Category II or Local Flags
Category II flags are local. Each site can create and
maintain its own set of local flags that are not transmitted to other sites.
However, the purpose of Category II flags is similar to Category I—to provide
important patient information to health care providers. For example, a site
could create a Patient Record Flags Cat II – Diabetes flag or a Category II
Infectious Disease flag.
In VHA Directive 2010-053, dated December 3, 2010, titled: Patient Record Flags, VHA advised sites
to create and use Patient Record Flags sparingly so that users will notice
flags and pay careful attention to them. Creating a large number of flags for
many different reasons might lessen the impact of flags and cause staff to miss
important information. Both Category I flags and Category II flags require a
progress note to document the reason for placing a flag on the patient’s
record.
Creating, Assigning, and Maintaining PRF
Some sites may have two different groups of users who work
with Patient Record Flags: administrative users who create, maintain, and
assign flags and the clinical users that document why the flag was placed on
the patient’s record. Authorized users can define Category II flags and edit
their definitions. They assign and maintain the flag on a patient’s record
using the assignment actions in the PRF software through the List Manager
interface: new assignment, continue,
inactivate, mark as entered in error, and reactivate. (Additional documentation
for PRF creation, assignment, and maintenance is available in the Patient Record Flags User Guide.)
Documenting PRF
With CPRS GUI v.26, each Patient Record Flag action (new
assignment, continue, inactivate, reactivate, or mark as entered in error) must
have a linked progress note that clinically justifies any action taken.
Previously, each flag needed to have a progress note, but there was no link
between the note and the flag action. Now when the user writes a PRF progress
note, the user must link the note to a flag action. The note might also contain
references to supporting documentation.
In each flag definition, the user must select the previously
created PRF progress note title that will document the reasons for any flag
action. This is referred to as associating a progress note title with a PRF.
Before a title can be associated with a PRF, the title must be created either
by a patch for a national flag or by someone at the site for a local flag.
For example, if a user were defining a Wandering flag in the
PRF List Manager software, someone at the site must have already used TIU to
create the appropriate note title in the correct document class. Then, the user
defining the flag would associate a title such as, Patient Record Flag Category
II – Risk, Wandering, by selecting that title from the list of available PRF
progress note titles.
Once the flag and the progress note
title are associated, when the user writing a new progress note selects a PRF
progress note title, CPRS displays the flag actions on the selected patient and
whether each action has been linked to PRF progress note (Yes or No). For the
new PRF note, the user then selects the available flag action to create the
link between the note and the flag action.
Note: There is a one-to-one correspondence between
flag actions and progress notes. Each PRF action for a patient can only be
linked to one progress note; each progress note can only be linked to one flag
action.
Prerequisites to Writing PRF Progress Notes
Before users can write progress notes that document PRF, PRF
progress note titles must be set up correctly. Each PRF progress note title
must be associated with a specific flag definition, and users must be assigned
to the appropriate user classes to write specific kinds of notes. Also, someone
must have assigned the flag to the patient.
For users to write a progress note and correctly link the
note to a flag action, sites must complete the following set up:
•
To write a PRF note
for a category I flag, the user must belong to the DGPF PATIENT RECORD FLAG MGR
user class. Each site will be responsible for populating this user class.
•
Because Category II
Patient Record Flags are local, each site must determine if the site will
create a user class and business rules to govern which users can write Category
II PRF progress notes.
•
The PRF note titles
should follow the naming conventions described in the directive and be
descriptive enough that users can tell which note title corresponds to which
flag.
•
The flag definition
must contain the progress note title that documents actions for that flag—each
PRF note title can only be associated with one flag.
•
Category II PRF
progress note titles must be in the Patient Record Flag Cat II document class
under the Progress Notes document class to allow users to associate them with a
PRF Category II definition. If the titles are not in this document class, they
will not display when the user attempts to associate the title with a PRF
Category II flag nor will CPRS get the information about which flags actions
are linked. Progress note titles for Category I patient record flags are
defined and associated by national patch.
PRF Note Titles
Currently, there are two Category I flags: Behavioral and
High Risk for Suicide. The Progress Note titles for documenting the two flags
are:
•
Patient Record Flag
Category I (for the Behavioral flag)
•
Patient Record Flag
Category I – High Risk for Suicide
To help sites that will be creating local Category II flags,
four partially customizable Progress Note titles have been distributed:
•
Patient Record Flag
Category II – Risk, Fall
•
Patient Record Flag
Category II – Risk, Wandering
•
Patient Record Flag
Category II – Research Study
•
Patient Record Flag
Category II – Infectious Disease
Clinical Application Coordinators
(CACs) can customize these titles by changing the text after the dash using TIU
utilities. For example, the first title could be changed from “Patient Record
Flag Category II – Risk, Fall” to “Patient Record Flag Category II –
Behavioral, Drug Seeking” or other titles sites create. CACs can also create their own titles, but
the title must follow the naming convention “Patient Record Flag Category II – other text” where other text is the text specific to the local note title.
Linking PRF Notes to Flag Actions
In the CPRS GUI, users must link a PRF progress note to a
flag action when the user writes a PRF note. This linking can also be done
through the List Manager interface using TIU options. In the CPRS GUI’s
Progress Note Properties dialog, when a user selects a Patient Record Flag
progress note title, CPRS displays a list of flag actions to which the note can
be linked at the bottom of the dialog. This list shows all the actions for the
flag and whether each action has been linked.
For
progress note titles that document the justification for a patient record flag,
users will be able to link the progress note to the specific flag action they
are documenting. The example shown here is of a Category I Behavioral PRF
progress note and new Edit Flag’s X action–‘DBRS/Other Field Edit Only’.
Several actions that can be linked to a note are displayed below
Note: For PRF
notes, users must select a flag action to link the note to before they can
write the note—the same way users link a note with a consult. CPRS will not
allow the user to write the note unless an unused flag action is selected. If
the user does not select a flag action, CPRS displays a dialog that states,
“Notes of this title require the selection of a patient record flag action”.
When the user selects a PRF progress note title, CPRS
displays this list of note actions only if sites have done the correct set up
as described earlier. The user must then pick the action (new assignment,
inactivate, reactivate, continue, entered in error, or DBRS/Other Field Edit
Only) that the note is documenting.
If a user is viewing a note and wants to see to which PRF
action the note is linked, the user can select View | Details on the Notes tab.
The details include the flag name, the date, and the action that was linked.
If a user writing a new progress note chooses a PRF progress
note but CPRS does not display any flag actions for linking, one of the
following has probably occurred:
•
The flag has not been
assigned to this patient yet.
•
The user has selected
the wrong progress note title for the flag.
•
If it is a Category I
flag, the site may not own the flag.
Marking PRF as Entered in Error
Marking PRF as entered in error terminates the flag’s
display in the patient’s record. However, if there was a progress note linked
to the flag, the progress note is still in the patient’s record. If the flag
was entered in error, an authorized TIU user should retract or retract and
reassign the linked progress note.
Note: Users
should be aware that although the flag does not display, a history of this flag
is kept in the Patient Record Flag software and users can reactivate the flag.
To prevent users from entering notes on previous, inaccurate PRF actions, all
previous PRF actions are hidden when a flag is marked as entered in error.
Viewing PRF in CPRS GUI
Patient Record Flags are displayed in the applications that
use the patient look up, including the CPRS GUI. In the CPRS GUI, there are
three places where users can see if a patient has PRF:
•
The Patient Record
Flag pop-up box
•
The CPRS Cover Sheet
•
The Flag button
(available from any tab)
When the user selects a patient name, CPRS begins to load
the record, displays any relevant messages (“means test required”, deceased
patient, sensitive record, etc.), and then, if the record is flagged, displays
a pop-up box with the flag titles for the selected patient to ensure that the
user sees the flags. The pop-up box is shown below.
The Patient Record Flags pop-up box displays a list of all
flags for the patient, with the first flag in the list highlighted and the
narrative for that flag displayed below the flag list and a list of links to
notes that have been linked to flag actions. Category I flags are displayed
first, followed by any Category II (or local) flags.
The flag narrative is the text the person assigning the flag
enters that they want the user to see. It should give the purpose of the flag
and may also contain examples of past behavior and instructions for users to
follow when encountering the patient. For example, the narrative for a
particular Behavioral flag might state that a patient has been known to carry
weapons and has verbally threatened VHA staff in the past. It may also
recommend that users call the VA police if this patient comes in for care. However,
the purpose of Patient Record Flags is not to stigmatize nor discriminate,
rather it is to protect VHA staff and patients and to ensure the efficient
delivery of health care.
On the bottom of the Patient Record Flags popup box, CPRS
displays a list of notes that are linked to specific flag actions. Links will
only display for those notes that have been signed and linked to a flag action.
When the user selects a link, CPRS displays the linked progress note for the
action in a detailed display window.
The Facility that created the Flag Action (if available)
will be listed in the bottom portion of the Progress Notes Properties box as
shown.
If a Flag Action was taken by a user
in the same signed-in division, the name of the Facility will be displayed as
shown in the above screen shot. If the Flag Action was taken by a user in a
site other than the signed-in division, the value of ‘UNKNOWN’ will be
displayed for Facility, as shown in the screen shot below.
Users
can now sort the Flag Action list by any of the provided data columns;
Facility, Date, Action or Note
Users can review the flags or close the box.
When the user is already in a patient record and wants to
view Patient Record Flags, the user can use either the listing on the Cover
Sheet or the Flag button. On the CPRS Cover Sheet, a new box called Patient
Record Flags has been added above the Postings area. Flags for the selected
patient are listed in the box.
The Flag button is visible from all CPRS tabs. If a
patient’s record has been flagged, the Flag button with its red text displays
next to the Remote Data button. If the patient’s record does not have any
flags, the text on the button is grayed out instead of red. The Cover Sheet and
Flag button are shown in the graphic below.
![]()
This
screen capture shows the red text on the Flag button indicating this patient
record has PRF and shows the flag list on the CPRS Cover Sheet
To view a Patient Record Flag when entering a record, use
the following steps:
1.
Select a patient from
the Patient Selection screen by either double-clicking on a patient name or
highlighting the name and pressing the <Enter> key.
Note: When the record loads,
CPRS checks to see if the record is sensitive and displays a warning to the
user that the user must acknowledge to proceed. Then, if the record has one or
more flags, CPRS displays a pop-up box with the patient’s record flags title.
The first flag is highlighted and the narrative details displayed below. If
CPRS displays the pop-up box, the user must close this box before CPRS will
load the patient chart.
2.
Then, select the Flag
title to view the narrative by clicking the flag name or highlighting the flag
name with the tab and arrow keys and pressing <Tab> (note that the number
of flags in each category is listed after the category label).
Note: If the provider has an NPI, it will not display on the
screens below.
This graphic shows the Patient
Record Flag pop-up box listing the patient’s flags, the narrative for the
highlighted flag, and the links to any signed, linked progress notes
documenting the reasons for the flag. Using the Flag button or clicking on a
flag title on the Cover Sheet also displays this pop-up box. Category I flags
are in the orange field, they blink, and the text changes color from white to
black and back. Category II flags are in the field below
This screen capture shows a Patient
Record Flag dialog with associated Behavioral flag and Disruptive Behavior
Reporting System information
Note: If the provider has an NPI, it will not display on the screen
above.
3.
To view the linked
progress note, select the appropriate link in the lower part of the dialog.
When finished, select Close.
4.
When finished viewing
the narrative, close the narrative box by choosing Close or pressing <Enter>.
To view a Patient
Record Flag when already viewing a record, use the following steps:
1.
Go the Cover Sheet by
clicking the Cover Sheet tab or pressing Ctrl
+ S or use the Flag button by
clicking Flag or pressing tab until you highlight the Flag button and press
<Enter>.
2.
Select the flag title
to see the narrative details by clicking the title or using the Up and Down
arrows to highlight the name and pressing <Enter>.
3.
When finished, close
the box by clicking Close or
pressing <Enter>.
History of Actions Taken
With patch OR*3.0*542 users can view a History of Actions
taken on active National Cat1 Patient Record Flags (PRF) (Behavioral, High Risk
for Suicide, and Missing Patient). Actions captured include: Reactivate,
Inactivate, Continue, and New Assignment. History is displayed by date in
descending order (newest to oldest), by action, by Site Identifier, and Site
Name.
Note: New Assignment will only be displayed when there are
ten (10) records or less displayed. When there are more than ten (10) records,
the following message is displayed “*** Additional information is in VistA
***”.
The figure below is an example of Active PRF History of
Actions Taken for a patient with less than 10 records; the history displays the
action of New Assignment.
The figure below is an example of a patient with more than
ten (10) history records, and thus the system display ***Additional Information is in VistA***.
PRF Notes
On the bottom of the Patient Record Flags popup box, CPRS
displays a list of notes that are linked to specific flag actions. Links will
only display for those notes that have been signed and linked to a flag action.
When the user selects a link, CPRS displays the linked progress note for the
action in a detailed display window.
The Facility that created the Flag Action (if available)
will be listed in the bottom portion of the Progress Notes Properties box as
shown.
If a Flag Action was taken by a user in the same signed-in
division, the name of the Facility will be displayed as shown in the above
screen shot. If the Flag Action was taken by a user in a site other than the
signed-in division, the value of ‘UNKNOWN’ will be displayed for Facility, as
shown in the screen shot below.
Users
can now sort the Flag Action list by any of the provided data columns;
Facility, Date, Action or Note
Users can review the flags or close the box.
When the user is already in a patient record and wants to
view Patient Record Flags, the user can use either the listing on the Cover
Sheet or the Flag button. On the CPRS Cover Sheet, a new box called Patient
Record Flags has been added above the Postings area. Flags for the selected
patient are listed in the box.
The Flag button is visible from all CPRS tabs. If a
patient’s record has been flagged, the Flag button with its red text displays
next to the Remote Data button. If the patient’s record does not have any
flags, the text on the button is grayed out instead of red. The Cover Sheet and
Flag button are shown in the graphic below.
This
screen capture shows the red text on the Flag button indicating this patient
record has PRF and shows the flag list on the CPRS Cover Sheet
To view a Patient Record Flag when entering a record, use
the following steps:
1.
Select a patient from
the Patient Selection screen by either double-clicking on a patient name or
highlighting the name and pressing the <Enter> key.
Note: When the record loads,
CPRS checks to see if the record is sensitive and displays a warning to the
user that the user must acknowledge to proceed. Then, if the record has one or
more flags, CPRS displays a pop-up box with the patient’s record flags title.
The first flag is highlighted and the narrative details displayed below. If
CPRS displays the pop-up box, the user must close this box before CPRS will
load the patient chart.
2.
Then, select the Flag
title to view the narrative by clicking the flag name or highlighting the flag
name with the tab and arrow keys and pressing <Tab> (note that the number
of flags in each category is listed after the category label).
Note: If the provider has an NPI, it will not display on the
screens below.
This graphic shows the Patient
Record Flag pop-up box listing the patient’s flags, the narrative for the
highlighted flag, and the links to any signed, linked progress notes
documenting the reasons for the flag. Using the Flag button or clicking on a
flag title on the Cover Sheet also displays this pop-up box. Category I flags
are in the orange field, they blink, and the text changes color from white to
black and back. Category II flags are in the field below
This screen capture shows a Patient
Record Flag dialog with associated Behavioral flag and Disruptive Behavior
Reporting System information
Note: If the provider has an NPI, it will not display on the screen
above.
3.
To view the linked
progress note, select the appropriate link in the lower part of the dialog.
When finished, select Close.
4.
When finished viewing
the narrative, close the narrative box by choosing Close or pressing <Enter>.
To view a Patient
Record Flag when already viewing a record, use the following steps:
1.
Go the Cover Sheet by
clicking the Cover Sheet tab or pressing Ctrl
+ S or use the Flag button by
clicking Flag or pressing tab until you highlight the Flag button and press
<Enter>.
2.
Select the flag title
to see the narrative details by clicking the title or using the Up and Down
arrows to highlight the name and pressing <Enter>.
3.
When finished, close
the box by clicking Close or
pressing <Enter>.
Inactive PRF History
Users may view Inactive PRF History for Patients who have an
Inactive Flag assignment. The Inactive Flag displays only for the following
National Category 1 (one) flags:
● High Risk for Suicide
● Missing Patients
The image below is an example of the location of the Inactive Flag.
Location
of Inactive Flag
The image below is an example of a patient who is not PP or
OTH with an Inactive Flag assignment.
Inactive Flag hover text reads: Patient has Inactive Flag(s) click to view.
Clicking the Inactive Flag opens the CPRS Patient Chart; the
figure below is an example of the CPRS Patient Chart.
Example
of an Inactive Flag Assignment
Note: In the example above, information regarding the
patient’s eligibility for OTH or PP is displayed first followed by Inactive
Flag Assignment. See the table below for field name and description for
Inactive Flag assignment.
Inactive Flag Assignment Field and Description
|
Field Name
|
Description
|
|
Flag Name
|
This field identifies flag
assignment for High Risk for Suicide or Missing Patient only.
|
|
Initial Assignment Date
|
Date and time stamp of the
initial flag assignment.
|
|
Originating Site
|
Identifies the site who
initiated the flag assignment
|
|
Owner Site
|
Identifies the site who
owns the flag assignment
|
Flag Assignment actions are organized by the site. Actions
displayed are: Inactivate, Reactivate, and Continue with the date/time stamp of
the action in descending order (newest to oldest). Since there is not a scroll
bar on the patient chart pop-up, when there are more actions available than can
be displayed, users will see the following disclaimer: ***Additional information is in
VistA***
Viewing Inactive Flag History
To view Inactive Flag History for PP or OTH Patients, follow
the steps below:
- Locate/Search for Patient
- Navigate to OTH or PP/Inactive Flag button
- Click on OTH or PP/Inactive Flag button
- Review OTH/PP eligibility and Inactive Flag
History.
*Note: OTH-90 button label only displays when the patient
has an inactive flag; otherwise, button label reads OTH with the number of days
remaining.
Remote Data
Note:
The Remote Data View (RDV) button will always be active.
You can view remote patient data with CPRS if Master Patient
Index /Patient Demographics (MPI/PD)
and several other patches have been installed at your site. If these patches
have been installed and the proper parameters have been set, you can access
remote data generated at other VA and Department of Defense (DOD) facilities.
The
Remote Data and VistaWeb buttons
The CPRS user now has two choices for viewing remote data.
One is the traditional Remote Data View (which has been streamlined), the other
is VistAWeb. Each system has its advantages.
Note: The Joint
Legacy Viewer (JLV) is a new way to view remote data and will
eventually replace VistaWeb. JLV is available now. Some
sites may not switch to JLV until VistAWeb is decommissioned, while others may
choose to transition sooner. This transition should be made in collaboration
with local Informatics staff and the JLV team. When the change occurs, the
existing VistaWeb button can be renamed and redirected to take the user to the
JLV.
The rest of this section details Remote Data Views. If you
want to use VistAWeb, documentation is available on the VistAWeb VA intranet
page.
If the patient has remote data, the VistaWeb button text
changes color to blue. If the user selects the VistaWeb button, the button
changes appearance to look as if it is depressed. It will keep that appearance
until the user selects a new patient.
When VistaWeb is launched by CPRS Context Management is
maintained. This means that VistAWeb will change patients whenever you select a
different patient in CPRS.
How Do I Know a Patient Has Remote
Medical Data?
As part of opening a patient record, CPRS checks in the
Treating Facility file to see if the selected patient has been seen in other
facilities. If the patient has remote data, the words on the Remote Data button
turn blue as shown in the image below. If there is no remote data for the
selected patient, the letters are gray.
The following graphic shows the Remote Data button with the
blue text indicating that there is remote data. When the user selects the
button, CPRS displays the list of sites that tells the user where and when the
patient has been seen.
If the Remote Data button is blue,
other facilities have data for the current patient
What Does the List of Sites Represent?
If you click the Remote
Data button, a drop-down list appears with the name(s) of sites where the
patient has been seen. This list is based on either:
•
Sites that have been
specifically designated for your facility to access. These sites are assigned
in a parameter that your Clinical Applications Coordinator (CAC) can set up.
•
All sites where the
patient has been seen and HDR and Department of Defense remote data if it is
available.
What Kind of Data Can I View?
Currently with CPRS, you can view some lab and health
summary components. There are limitations to what you can view.
•
You can view any lab
results that do not require input other than a date range.
•
All reports listed on
the Reports tab unless they are labeled "local only"
•
You can view health
summary components that have the same name on both the local and the remote
site. You can therefore exchange national Health Summaries, but locally defined
components may not be available unless the other site also has a component with
the same name.
•
If it is available,
CPRS can also show some Department of Defense remote data.
How Will the Remote Data Be Viewed?
Viewing remote data is a two-step process. First, you select
which remote sites you want to see data from, and then you select the specific
information you want to view, such as Clinical Reports or Health Summary
components.
On the Reports tab, each site you select will have a
separate tab for its data. Using the above graphic as an example, you would see
five tabs on the Reports tab: Local, Dept. of Defense, Devcur, Loma Linda, Ca.,
and Office of Information.
You would then select the reports you want to view and a
date range (if necessary). After this, CPRS will attempt to retrieve those
reports if they are available on the remote sites. You would then click each
Treatment Facility’s tab to see the report from that site. While CPRS is
attempting to retrieve the data, the message “Transmission in Progress:” is
displayed until the data is retrieved.
Viewing Remote Data
The CPRS user now has two choices for viewing remote data.
One is the traditional Remote Data View which has been streamlined, the other
is VistAWeb. Each system has its advantages.
The rest of this section follows Remote Data Views. If you
want to use VistAWeb, documentation is available on the VistAWeb page.
To view a patient’s
remote data, use these steps:
1.
After opening the
patient’s record, see if the text on the Remote Data button is blue. If the
text is blue, the patient has remote data.
2.
Select the tab you
want remote data from (e.g. Labs or Reports).
3.
Select the Remote Data button to display a list of
sites that have remote data for the patient.
4.
Select the sites you
want to view remote data from by selecting the check box in front of the site
name or select All and select the Remote
Data button again to close the list.
5.
Select the report or
lab you would like to view from the Available Reports or Lab Results section on
the left side of the screen (click the “+”
sign in order to expand a report heading).
Note: With the exception of
the DoD Consults report, choosing a Department of Defense (DoD) report does not
limit you to DoD data. For example, if you choose Microbiology under Dept. of
Defense, you will get DoD data and remote VAMC data. You do not have to run a
separate report to get VA data.
It may take a few minutes to
retrieve the data. While CPRS retrieves the data, the message
"Transmission in Progress" is displayed.
Depending on how the report or lab
is configured, CPRS will return the remote data in one of two ways.
•
Text Format with Site
Tabs
If the remote data is in text
format, the data from each remote site will be displayed under a separate site
tab. To view data from a particular site, select the appropriate tab.
Note: If the provider has an
NPI, it will not display on the screen below.
Site tabs organize remote data from
different sites
•
Table format
If the report or lab is available
in table format, CPRS will return data from all of the sites in a single table.
The "facility" column indicates where the data in a particular row
was collected. The table can be sorted by facility or by any other column
heading (alphabetically, numerically, or by date) by selecting the appropriate
heading. Selecting the heading again will sort the table in inverse order.
Remote data is displayed in a table
format
6. To see detailed information about a
particular item in the table, click that item. If detailed information is
available, it will be displayed in the bottom half of the screen. To select
multiple rows, press and hold the Shift or Control key.
The Reminders Button
The CPRS GUI includes functionality from Clinical Reminders.
Reminders are used to aid physicians in performing tasks to fulfill Clinical
Practice Guidelines and periodic procedures or education as needed for veteran
patients.
Note: For more detailed information on
Reminders, refer to the Clinical
Reminders Manager Manual and the Clinical
Reminders Clinician Guide.
The Reminders button highlighted in red below shows you at a
glance whether the patient has reminders that are due.
The
Reminders button
By observing the color and design of the icon on the
Reminders button, the user receives immediate feedback on the most important
types of Reminders available for the selected patient. Clinical Coordinators
can set Reminders to be evaluated when you open the chart or they can set it to
evaluate the Reminders only after you select the Reminders button or the Reminders
drawer.
The following icons could be visible on the Reminders
button:
Due:
The patient meets all the conditions for the reminder and the appropriate
amount of time has elapsed.
Applicable: The patient meets all
the conditions for the reminder, but the appropriate time has not elapsed. For
example, a flu shot is given once a year, but it has not been a year yet.
Other:
Reminders have been defined, but were not specifically evaluated for the
selected patient. An important education topic might be placed in Other.
Question
Mark: A question mark on the Reminders button indicates that the reminders have
not yet been evaluated. This appears when the patient’s chart is first opened
to a tab other than the Cover Sheet. Click the Reminders button or the
Reminders drawer on the Notes tab to evaluate the reminders.
Grayed-out
Alarm Clock: This icon indicates that there are no due nor applicable
reminders, nor are there any reminder categories available.
If you click the button, you will
see a tree view of the patient’s reminders such as the one shown below. The
icons that appear on the Reminders button are also used in the tree view to
identify the various types of reminders.
The
Available Reminders tree view
Additional information on Reminders is located in the Cover
Sheet section of this manual.
The Reminders tab on the Icon Legends dialog includes a
description of the different icons that appear on the Reminders tree view. To
access the Icon Legend, select View
| Reminder Icon Legend | and the Reminders
tab.
The
Icon Legend
Postings (CWADPL)
Postings contain critical patient-related information about
which hospital staffs need to be aware.
The Postings button is
visible on all tabs of the CPRS GUI window and is always located in the upper
right corner of the window
If a patient record contains postings, the Postings button displays one or more of
the following letters: C, W, A,
D, P, and L. These letters
correspond to the six types of postings described below.
•
C (Crisis Notes) – Cautionary information about critical
behavior or patient health.
Example: Suicidal attempts or threats.
•
W (Warnings) – Notifications that inform medical center
staff about possible risks associated with patients.
Example: Patient can be violent.
•
A (Adverse Reactions/Allergies) – Posting that displays information about medications,
foods, and other items to which patients are allergic or to which they may have
an adverse reaction. CPRS creates these postings automatically when users enter
allergies.
•
D (Directives) – Also
called advanced directives, directives are recorded agreements that a patient
and/or family have made with the clinical staff.
Example: DNR (Do Not Resuscitate) directive on file.
•
P (Pregnant) –
Indicates that the patient is currently pregnant.
•
L (Lactating) –
Indicates that the patient is currently lactating or nursing.
The Postings button
Viewing a Posting
CPRS offers two ways to View a posting. You can view a
posting by clicking the Postings button from any chart tab, or you can select a
specific posting from the Cover Sheet tab.
To view a posting by using the Postings button, follow these
steps:
1.
Select the Postings
button or select View | Postings from the Cover Sheet tab.
The Patient
Postings dialog appears. The Patient
Postings dialog contains all postings for the selected patient. The
postings are divided into two categories. Allergies are listed in the top half
of the dialog and crisis notes, warning notes, and directives are listed in the
bottom half.
The Patient Postings dialog
- Select a posting to see a detailed
explanation.
CPRS displays a new window that
contains the full text of the posting.
- When you are finished reading the posting,
select Close.
To view a specific posting from the Cover Sheet, follow
these steps:
1.
Select a posting from
the Postings or Allergies / Adverse Reactions area of the Cover Sheet.
CPRS displays a new window that
contains the full text of the posting.
2.
When you are finished
reading the posting, select Close.
COVID-19 Identifier/New EHR
Banner
CPRS now displays a patient's COVID-19
status in a banner visible on any CPRS tab as shown below.
In this example, the banner shows that the
patient is positive for COVID-19 and the date.
However, if you are in an organization that has migrated to
a new EHR, the COVID-19 Identifier banner will be repurposed as a New EHR
banner, and will look like the screenshot below:
In this example, the banner shows that the site has
migrated to a new EHR
Patient Status Messages
The messages will be pulled from the
function finding found text in the reminder definition linked to the banner.
These messages will change as the reminder definition is updated. The status
document will be found on the following page:
REDACTED
Possible COVID-19 Status Error Messages
There are three error messages that users could see instead
of a status.
● Non-existent patient
● No reminder definition is defined
● Reminder evaluation failure, status: <error text>
If you see one of these error messages, please record the
patient name and call the help desk for assistance.
CPRS Graphing
CPRS includes graphing functionality that enables you to
create visual representations of relationships between many types of patient
data. Specifically, CPRS graphing supports data from the following indexed
sources:
• Admissions •
Lab tests • Patient
education • Surgery
• Allergies •
Medication * • Problems • Visits
• Anatomic pathology •
Medicine • Procedures • Vitals
• Blood bank •
Mental health • Purpose of
visit
• Exams •
Microbiology • Radiology
exams
• Health factors •
Notes •
Registration **
• Immunizations • Orders • Skin tests
*
Includes BCMA, inpatient, non-VA, and outpatient
** Includes Dx and
Op/Proc
What You See and What You Get
CPRS graphing uses different representations for different
types of items. Following is a brief discussion of selected items and their
corresponding representations.
Admissions and Visits: CPRS graphing displays visits and
admissions on the horizontal (date/time) axis as lines or bars that indicate
the duration of the visits and admissions. Bars representing hospital
admissions begin at the date and time of admission and end at the date and time
of discharge. Visit representations begin at the appointment date and time and
end at the date and time of the visit’s end. Because visit durations are often
short, visit representations are typically vertical lines, rather than bars.
When visit durations are unavailable, CPRS graphing uses its default duration
of one hour.
Events: CPRS
graphing displays as single events all items that are not laboratory tests,
vitals measurements, medications (inpatient, non-VA, or outpatient), or visits.
Like representations for admissions and visits, representations for single
events use only the horizontal axis. CPRS graphing uses triangle shaped
representations to mark these items. (Color, shape, and height differentiate
item markers.) It graphs administration times for BCMA medications as events.
Medications: As
it does with admissions and visits, CPRS graphing displays medications as bars
that indicate a period of time. In the case of outpatient medications, bars
begin on the horizontal axis at the release date of the medications. End dates
are based on the following calculation: medication release date + number of
days’ supply = end date. For inpatient and non-VA medications, bars begin at
medication start times and dates and end at medication stop times and dates. In
the case of non-VA medications, if no stop date exists, CPRS graphing uses the
current date as the stop date.
CPRS graphing differentiates
multiple medications by color and vertically offsets them to ensure the
visibility of overlapping bars.
Important: Healthcare
professionals have no reliable way to determine whether patients do or do not
take their outpatient medications. Use caution when graphing relationships
between outpatient medications and other items.
Vitals: CPRS
graphing displays vitals measurements as points on two axes. If more than one
measurement exists for a given date and time, CPRS graphing connects
measurements for like items with a line.
Labs:
CPRS
graphing also displays as points on two axes laboratory tests that have results
with numerical values. Lines connect like items.
CPRS graphing displays lab tests
with non-numerical results (positive and negative results, for example) as
points on the horizontal axis. It does not connect like items that have
non-numerical results. To keep them out of the way of numerical data, CPRS
graphing displays non-numerical results above or below the numerical values and
line. Values beginning with > are located at the top margin; others are
graphed at the bottom margin. Free-text values display by default as do
comments. To hide or show free-text values, click on the “free-text values:”
label. Comments are displayed in yellow boxes on the date axis, while the
**comments label shows that there are comments. Clicking this label will show
details of all items on the graph.
CPRS
graphing includes reference ranges in graphs of laboratory test results.
Reference ranges are displayed as dashed horizontal lines.
A lab test from different
specimens or having different reference ranges will display in separate graphs
with the appropriate reference range. If the Merge Labs setting is used then
the lab tests will be graphed as a single test (with a warning that different
reference ranges are present).
Using CPRS Graphing
The following sections explain how to:
•
Start CPRS
graphing
•
Configure settings
•
Create graphs
•
View details for
graphed items
•
Use the zoom feature
to expand areas of interest
•
Copy and paste or
print graphs
Starting CPRS Graphing
CPRS displays its graphing functionality as a detached
window or a group of panes embedded within the Reports tab. (CPRS supports one
detached instance of the graphing window and one Reports-tab instance per
session.)You can resize and move the detached window, which enables you to set
up graphs as a reference that you can view as you navigate your patient’s chart
in CPRS
You can start CPRS graphing in any of the following
ways:
•
From any tab: click Tools on the main menu and then click Graphing. CPRS displays the detached
graphing window.
•
From any tab:
simultaneously press the <Ctrl>
and <G> keys. CPRS displays
the detached graphing window.
•
On the Reports tab: click Graphing (local only) under Available
Reports. CPRS displays embedded graphing panes.
•
On the Labs tab: click Graph under Lab Results. CPRS
displays the detached graphing window.
•
On the Labs tab: click Most Recent under Lab
Results and then click on any test displaying lab results.
You can then display graphs by
clicking items in the lists on the Views tab or the Items tab (located in the graphing window’s left-hand pane).
The
Graphing Window is a standalone window where users can review data and
configure their graphing. It has many options for view data. Users should use
the Setting button to configure the windows display and Select/Define… to
create personal or shared views
Configure Settings
CPRS graphing offers many options for selecting and
displaying graphed data. For example, you can:
•
Select a date range
•
Create, edit, delete,
and rename predefined views (personal or public)—or save collections of items
for reuse
•
Display individual or
multiple items in a single graph
•
Display graphs in one
single or two separate panes
•
Use the Graph Settings dialog box to specify
data sources and display options
Following are instructions for using these options to create
customized graphs.
Setting Display Options on the Main Window
You can set several display options directly from the main
window, including the following options:
•
Date range
•
Single- or split-pane
display
•
Individual or
multi-item graphs
•
Pane size
Selecting a Date Range
If the user has not specified a date range using the Graph
Settings dialog and saving the items as a personal default and a public date
range has not been defined, CPRS graphing uses a date range (All Results) that encompasses all
available items for the selected patient. However, all results may bring in a
lot of data depending on the
Items or View defined. Users can set a default date range by
selecting the Settings… button or using the Tools | Options… menu items,
selecting the Graphs tab, and selecting Default Graph Settings….
For the current view, users can change this date range by
selecting a new date range from the Date
Range list (one week, six months, two years, All Results, etc.), or by
using the Date Range dialog box to
define a range.
To access the Date Range dialog box:
•
Select Date Range… in the Date Range list. This sets the date range for the current view.
Keep in mind the following information when selecting a new
date range:
•
CPRS graphing
automatically displays all available items for the selected date range. If no
items appear in the Item list, the system has no items that fall within the
date range you’ve selected.
•
Date ranges apply to
all graphs. That is, you cannot simultaneously graph items using multiple date
ranges.
•
If items cover a date
range that extends beyond the range you’ve selected, the graphing tool uses the
absence of boarders to visually suggest that the items continue beyond the
selected date range.
Displaying Individual or Multi-Item Graphs
Each graph in the display area (or split-pane areas) can
include one or multiple items.
To create graphs that include only one item on each set of
axes:
•
Select the Individual Graphs checkbox (located in
the upper left-hand section of the main graphing display).
To create graphs that include multiple items on each set of
axes:
•
Cancel the selection
of the Individual Graphs
checkbox.
While you can graph one or more vitals and lab measurements
on the same set of axes, you cannot graph vitals and lab measurements on a set
of axes that includes other types of items.
Creating a Split-Pane Display
CPRS graphing offers a split-pane display that enables you
to create separate graphs in the top and bottom panes. Each pane includes its
own Individual Graphs check box, View tab, and Item tab.
To create a split-pane display:
•
Select the Split Views check box located in the
lower left-hand section of the main window.
To return to a single-pane display:
•
Cancel the selection
of the Split Views check box.
Resizing Panes and Item-Selection and Views Columns
Take the following steps to resize panes and item-selection
columns:
1.
Point to the border
between panes or columns.
2.
When the pointer
becomes a ![]()
, click and hold the
left mouse button.
3.
Drag the border to its
new location and release the mouse button.
Creating Predefined Views
CPRS graphing provides predefined graphs through its View tab, which is located in the upper left-hand pane of the main window.
This tab includes all predefined views from the following sources:
•
Public views you or
others—your site’s IRM staff, for example—have created. (Only authorized users
can create public views.)
•
Private views you have
created.
•
Personal Lab Groups
that you have created. These lab groups are defined in the Lab Worksheet
report.
Users can now also access other users’ personal views and
lab groups that they have defined to build new views. Users with proper
authority can save personal views as public views by simply renaming and saving
as a public view. Users can also save public views as a personal view and then
alter it to suit their personal preferences.
To display view definition, users do this:
1.
Highlight the view
name.
2.
Select View Definition
from the pop-up menu.
The definition with them display in a pane below View list.
Take the following
steps to create new views:
1.
Access the Define
Views or Select Items and Define Views dialog box using one of the following
four methods:
a.
On the CPRS main
menu, click Tools and then click Options. CPRS displays the Options dialog box.
i.
On the Graphs tab, click View Definitions. CPRS displays the Define Views dialog box.
-or-
b.
Click Select/Define on the right-click menu
from the graphing window. CPRS displays the Select Items and Define Views dialog box.
-or-
c.
Click Select/Define at the bottom of the
graphing window. CPRS displays the Select Items and Define Views dialog
box.
-or-
d.
On the CPRS Reports tab, click Graphing (local only) in the Available
Reports list. CPRS displays embedded graphing functionality.
i.
Click the Select/Define button. CPRS displays the
Select Items and Define Views dialog
box.
- Select All Items in the Select Items using area located at the top
of the dialog.
- Select a data source from the Source list. CPRS displays in the
Items list all items associated with this source.
- If you know you want to include all items,
double-click the source to add it—and its associated items—to the Items
for Graphing list. You can also add all items for the source by clicking
the
button.
-or-
Double-click individual items you
want to add to the Items for Graphing
list. You can also select individual items by highlighting them and then
clicking the > button.
Other tips for adding items to the
Items for Graphing list:
●
Select Drug Class in the Source list to make available for selection all drugs (inpatient, outpatient, non-VA, and BCMA).
●
Select Medication, BCMA; Medication, Inpatient; Medication,
Outpatient; or Medication, Non-VA
to display only medications for these sources. For example, if you want to
select a specific outpatient medication, click Medication, Outpatient and then add the medication to the Items for Graphing list.
●
In the Source list, Anatomic Pathology and Microbiology
include sub sources. When you select the primary sources (Anatomic Pathology or Microbiology),
CPRS graphing displays their sub sources in its Items list. If you add to the Items
for Graphing list sub sources from the Items
list, you automatically add all items associated with the sub sources. To add
individual items associated with sub sources, select the sub sources from the Source list.
●
CPRS moves all
selected items to the Items for Graphing
list. If you select duplicate items from different sources, CPRS merges the
duplicate items when you add them to the Items
for Graphing list.
- (Optional) You can remove items from the Items for Graphing list by
double-clicking them. You can also use the < button or the <<
button to remove items.
- Repeat steps 2–5 until you have selected all items that you want to
include in your view.
- Select Save Personal to save these items in a personal view or, if
you are authorized to do so, click Save Public to save the items in a view
that is available to all users.
- In the Save your Personal View or Save this Public View dialog box,
type a name for your new view. CPRS saves view names in all capital
letters and displays them using title caps. Therefore, you cannot use
capitalization schemes to save different views that have the same name.
You must give each view a new name unless you plan to overwrite an
existing view.
- Select OK.
Your view is now available on the Source list in the Select/Define and Select
Items and Define Views dialog boxes.
It is also available on the View
list.
Editing Predefined Views
Take the following
steps to edit predefined views:
1.
Access the Select Items and Define Views or Select/Define dialog box. (See step 1
in “Creating Predefined Views” on p.113 of this manual.)
2.
Select the view you
want to edit. (Views are located near the bottom of the Source list.) CPRS displays the view—and the items that comprise
it—in the Items list.
3.
Double-click items you
want to keep in the view. CPRS displays these items in the Items for
4.
Graphing list. (You
can also use the right-arrow or double right-arrow buttons to move items from
the Items list to the Items for Graphing list.)
5.
Make additional
changes to the Items for Graphing
list as needed. (Add items from additional sources by clicking sources in the Source list and then selecting
associated items from the Items
list.)
6.
Select Save Personal or Save Public, depending on whether you are editing a personal or
public view. (Again, only authorized users can create or edit public views.)
You can modify and/or save public views as personal views simply by clicking Save Personal.
7.
Type the name of the
view you are editing. (If you are saving a public view as your personal view,
the personal view can have the same name as its public counterpart.) Click OK.
8.
CPRS displays the Confirm dialog box, which warns you
that you are about to overwrite an existing view.
9.
To overwrite (edit)
the existing view, select Yes.
Deleting Predefined Views
Take the following
steps to delete predefined views:
1.
Access the Select
Items and Define Views or Select/Define dialog box. (See step 1 in “Creating
Predefined Views” on p.113 of this manual.)
2.
In the Source list, select the name of the
view you want to delete.
3.
Select Delete.
4.
CPRS displays the Confirm dialog, which asks if you want
to delete the selected view.
5.
To delete the view,
select Yes.
Renaming Predefined Views
Take the following
steps to rename a predefined view:
1.
Access the Select
Items and Define Views or Select/Define dialog box. (See step 1 in “Creating
Predefined Views” on p.113 of this manual.)
2.
In the Source list,
select the name of the view you want to rename.
3.
Select Rename.
4.
CPRS displays the
Rename your Personal View or Rename this Public View dialog box.
5.
Type a new name for
your personal or public view.
6.
Select OK.
7.
CPRS displays the Confirm dialog box.
8.
To change the name of
your view, select Yes.
Setting Display Options Using the Graph Settings Dialog Box
The Graph Settings
dialog enables you to specify particular sources that you want CPRS graphing to
display in the Item list (main
window). In addition, these dialog boxes include several display settings.
Accessing
the Graph Settings Dialog Box
To access the Graph
Settings dialog box:
1.
Select Tools on the CPRS GUI main menu.
2.
Select Options.
3.
CPRS displays the Options dialog box.
4.
On the Graphs tab,
select Default Graph Settings.
5.
Use the steps in the
following sections to specify settings.
Changes you make using this dialog box from the Tools menu may take effect only after
you close and restart CPRS.
Accessing the Graph
Settings Dialog Box
You can access the Graph Settings dialog box in any of the
following three ways:
1. Select the Settings button located on the bottom bar of the main window.
-or-
Select Settings on the right-click menu.
-or-
On the Reports
tab, select Graphing (local only) and then select the Settings button located below the Available Reports list.
Note: When you access the Graph Settings dialog box from the Reports tab, changes apply only to graphs you create from the Reports tab.
Regardless of how you access the Graph Settings dialog box, CPRS applies your changes only to graphs
you create during your current CPRS session unless you save them as your
default settings.
Specifying Sources
You can specify which sources CPRS graphing uses to display
items by taking the following steps:
1.
In the Sources
Displayed list, select the checkboxes adjacent to the sources you want to
include.
2.
To select all
available sources, select All.
3.
To cancel the
selection of all sources, select Clear.
Setting Display Options
CPRS graphing provides the following
display options through the Graph
Settings dialog box:
3D Select
this option if you want your graphs to appear three dimensional. This option is also available on the right-click
menu.
Clear Background Select
this option if you want your graphs to appear on a plain white background.
Dates Select this
option if you want to display dates along the horizontal (time/date) axis.
Fixed Date Range Select this item if you want
always to display the selected date range.
Gradient Select this option if
you want to display graphs against a gradient blue background.
Hints Select this
option if you want CPRS graphing to display hover hints that contain a brief
description of items to which you are pointing.
Legend Select this option
if you want your graphs to include a legend that identifies graphed items.
Lines Select this
option if you want graphs to include vertical lines along the horizontal
(date/time) axis. (Lines can help orient graphed items in time.)
Merge Labs Select this option if you
want lab tests to be graphed together regardless of specimen or reference
ranges.
Sort by Type Select this option if you
want CPRS graphing to sort items in its Item list by type.
Stay on Top Select this option if you
want the detached graphing window to stay on top. This option is also available
on the right-click menu.
Values Select this option
if you want to display values for graphed items. Free-text values display by
default.
Zoom, Horizontal Select this option if you want
the ability to select and expand graphed items with respect to the horizontal
(date/time) axis.
Zoom, Vertical Select this option if you
want the ability to select and expand graphed items with respect to both the
vertical and horizontal axes. (You can select this option only if you have also
selected the Zoom, Horizontal option.) This option is also available on the
right-click menu.
Max Graphs in Display Select the maximum number (1–20) of graphs
that you can display simultaneously.
Minimum Graph Height Select a minimum height (10–1000 pixels) for
each graph.
Max Items to Select Select the maximum number of items
(1–1000) you can include in a single graph.
Outpatient Date Default Select the date range for outpatient data
(Today, One Week, Two Weeks, One Month, Six Months, One Year, Two Years, All
Results)
Inpatient Date Default Select the date range for inpatient data
(Today, One Week, Two Weeks, One Month, Six Months, One Year, Two Years, All
Results).
Personal and Public Default Settings
To save changes for future CPRS sessions:
• Select the Personal
or Public buttons in the Save as Default area. You can save
settings as public defaults only if you are authorized to do so.
CPRS applies defaults only after you close and subsequently
restart CPRS. When you do this, CPRS applies your personal default settings. It
applies public default settings only if you have not saved personal default
settings.
Display Options Available through the Select Items and Define Views Dialog
Box
CPRS graphing enables you to display graphs directly from
the Select Items and Define Views
dialog box. Using this dialog box, you can specify the following display
options:
Top Select this option to display
your graph in a single-pane view, or to display it at the top of a split view
if the Split View checkbox on the main window is selected.
Bottom Select this option to display your
graph on the bottom pane of a split view.
Both Select this option to display
your graph in both the top and bottom panes of a split view.
No Change Select this option
if you want to use the display settings you’ve selected in the main window.
Creating Graphs
You can create graphs from the main window and from the Select Items and Define Views dialog
box.
Graphing Items from the Main Window
When you create graphs from the main window, you select
items from the View and/or Item list. The View list contains predefined groups of items that you have saved
as personal views, or that you or other users have saved as public views. (See
the “Creating Predefined Views” section on p.113 of this manual for more
information about creating views.)
The Item list
contains only items that are available for the patient and date range you have
selected. If no items appear on this list, try adjusting your data-source
settings. (See the “Specifying Sources” section on p.118 of this manual for
information about increasing the number of sources available for the Item list.) You can also try expanding
the date range you have selected.
If you haven’t already done so, set graphing display
options. (See the “Configure Settings” section on p.111 of this manual for
information about setting up display options.)
To graph a view or
single item:
•
In the Item or View list, click the item or view you want to graph.
To graph multiple
items, take the following steps:
1.
(Optional) Sort items
in the Item list by clicking a column header. (You can resize columns by
dragging—or double-clicking—the border between column headers.)
2.
In the View or Item
list, select a view or first item. If you click a view, CPRS graphing
automatically selects and sorts at the top of the Item list the items that
comprise the view.
3.
If you are selecting
items from the Item list, press and hold the <Ctrl> key or, if the items
you want to select are sorted to appear sequentially, press and hold the
<Shift> key.
4.
If you are pressing
the <Ctrl> key, click each additional item you want to add. (You can
cancel the selection of an item by clicking it again.) If you are pressing the
<Shift> key, click the last item in the sequence of items you want to
add.
5.
When you are finished
selecting items, release the <Ctrl> or <Shift> key. CPRS graphing
displays your graph (or graphs) in its right-hand pane.
Adjusting the Display
CPRS graphing automatically scales graphs to fit the pane.
However, you can resize the main window, or resize the pane. (See “Resizing
Panes and Item-Selection Columns” on p.113 of this manual.)
To split numerical items in your graph from
event-based items:
•
Select Split Numerics/Events on the
right-click or popup menu.
To reverse your split-screen view:
•
Select Swap on the right-click or popup menu.
To move a particular item from the bottom to the top of a split-pane
view, or vice-versa, or to separate a particular item from a multiple-item
graph:
•
Point to the item and
select Move on the right-click or
popup menu. If you are separating an item from a single-pane view, CPRS
graphing automatically displays the item in the bottom pane of a split-pane
view.
To move all items from the top to the
bottom pane of a split view, or vice-versa:
•
Point to an
unpopulated area of the pane containing the graphs you want to move and select Move from the right-click menu.
To remove a graphed item:
•
Point to the item and
select the Remove selection on the
right-click menu.
To remove all graphed items:
•
Point to an
unpopulated area of the pane from which you want to remove all graphed items
and select the Remove selection from
the right-click menu.
Graphing Items from the Select Items and Define
Views Dialog Box
When you create graphs from the Select Items and Define Views dialog box, you first select data
sources that include the items you want to graph. The Source list contains all data sources—including all saved public
and private views. The patient you have selected may not have items in a given
source.
If you haven’t already done so, set graphing display
options. (See the “Configure Settings” section on p.111 of this manual for
information about setting up display options.)
Take the following
steps to create graphs from the Select Items and Define Views dialog box:
1.
Select Patient Items in the Select Items using area located at the
top of the dialog.
2.
Select a source from
the Source list.
If the patient you’ve selected has
items from this data source, CPRS displays the items under the source’s name in
the Items list. Otherwise, it
displays only the source’s name.
3.
Double-click
individual items you want to include in the Items for Graphing list. You can also add items to this list by
using the > and > buttons. (The > button adds individual items to
the Items for Graphing list, and the
> button adds all items.)
4.
(Optional) Use the < and << button to remove items from the Items for Graphing list. You can also double-click items on this
list to remove them.
5.
Repeat steps 2–4 as
necessary to add items from additional sources.
6.
Select Close and
Display.
CPRS displays the resulting graph (or graphs) in the main
window. (See “Adjusting the Display” on p.121 of this manual for information
about adjusting this display.) It also displays graphed items (selected and
sorted at the top) in the Item list
and the temporary view in the View
list. Temporary views are available for creating subsequent graphs only during
the current CPRS session.
Displaying Details for Graphed Items
CPRS graphing offers several options for displaying details
associated with graphed items. The following list describes these options.
•
Hints: If you have
selected Hints in the Graph Settings dialog box, hover hints
containing summary information appear when you point to graphed items.
•
Values: If you have
selected Values in the Graph Settings dialog box—or if you’ve
selected Values on the right-click
menu—CPRS graphing displays informational labels for each graphed item.
•
Display details: When
you click on a graphed item, CPRS graphing displays details associated with the
item.
•
Click on legend: When
you click on a graph’s legend, CPRS graphing displays a limited-data listing
for all items that appear on the legend.
•
Display point details on right-click menu: CPRS graphing displays all results associated with
specific types of points when you right-click on the points and then click Details. For example, if you
right-click on a point that represents a vitals measurement for the selected
patient—his body temperature on July 24,
2000, say—and
then click Details, CPRS graphing
displays the results of all vitals measurements entered for July 24, 2000.
•
Display all details via the right-click menu: CPRS graphing displays details for all graphed items when
you when you right-click on an unpopulated area of the graph and then click Details on the right-click menu.
Using the Zoom Feature
CPRS graphing’s zoom feature provides a way to visually
expand areas of interest. To enable this feature for the horizontal axis,
select the Zoom, Horizontal checkbox
in the Graph Settings dialog box. To
simultaneously expand areas of interest along the vertical axis, select Zoom, Vertical in the Graph Settings dialog box or Vertical Zoom on the right-click
menu.
Take the following steps to visually expand areas of
interest:
1.
Point to the upper
left-hand corner of the area you want to visually expand.
2.
Click and hold the
left mouse button.
3.
Drag the mouse pointer
downward and to the right until you have described the entire area of
interest.
4.
Release the mouse
button. CPRS graphing expands the horizontal and (if applicable) vertical axes
of all graphs accordingly. In its information bar, CPRS graphing displays the
new (zoomed) date range.
5.
(Optional) Repeat
steps 1–3 as needed to further expand the area of interest.
Reversing the Zoom Process
To instantly return all graphs to their original state:
•
Select Reset Display on the right-click menu.
Alternately, you can
return all graphs to their original state by taking the following steps:
1.
Point to any area on a
graph.
2.
Click and hold the
left mouse button.
3.
Drag the mouse pointer
upward and to the left.
4.
Release the mouse
button.
To step backward
through the zoom process (reverse the process by increments):
•
Select Zoom Back on the right-click menu.
(When you’ve stepped backward through the entire zoom process, this menu
selection is unavailable.)
Copy and Paste or Print Graphs
The graphing tool relies on Microsoft Word’s copy, paste,
and print features. If Word is not installed on your machine; these features
are not available for you to use.
To copy all of the
graphs in the main window—including graphs that lie outside your
scrolled view:
•
Select Copy on the right-click menu.
To paste copied
graphs into any application that accepts copied images from the system
clipboard:
•
With the application
active, simultaneously press the <Ctrl>
and <V> keys.
You cannot paste graphs into progress notes and other
text-entry components of CPRS.
To print all of the graphs in the main window—including
graphs that lie outside your scrolled view:
•
Select Print on the right-click menu.
Exporting Data
Graph patient data can also be exported to a spreadsheet.
From the right click menu, Export Data automatically puts data into an Excel
spreadsheet. The Excel script uses a common auto-format after data is copied.
The user can then manipulate the data in the Excel spreadsheet (making other
graphs, sorting, applying functions, etc.). The patient info (same as used with
Word) is in Excel’s header and footer. The header and footer are only visible
when printing or doing a print preview.
The exported data is just a work copy, and any edits the
user makes in Excel do not affect the patient’s permanent record. Users can
also adjust the column width or do other formatting actions for more readable
printouts.
To export the data into an Excel Spreadsheet, use these
steps:
• After the selected data has been
displayed in a graph, select File |
Export Data.
Excel will then be launched and the data from the graph will
be displayed in the spreadsheet.
Electronic and
Digital Signatures
CPRS now has two types of signatures: electronic and
digital. Electronic signatures, which have been available for some time,
require an electronic signature code that can be created at your site. Digital
signatures in CPRS are now required to comply with new Drug Enforcement
Agency’s (DEA) regulations for identifying a prescriber that orders outpatient
controlled substances.
There are three different levels of keys that influence what
can be done with orders, including which dialog CPRS brings up when signing
orders. Although actual practice at each site may vary, the three levels are
usually referred to in these ways:
•
OREMAS is the clerk
key
•
ORELSE is the nurse
key
•
ORES is the provider
key
In CPRS, users who hold the ORES key have additional
privileges and are sometimes required to enter more information than those who
hold the ORELSE or OREMAS key. ORES key holders (usually an ordering provider)
must enter information regarding service connection, environmental conditions
or specific treatment factors, such as ionizing radiation, Agent Orange, etc.
This section describes the differences between electronic
and digital signatures, gives an overview of service connection and treatment
factors, and then gives the steps for the various ways users will sign orders.
For example, users can sign orders several different ways:
•
Review / Sign Changes…enables
users to sign all orders from the current ordering session. Using this method,
the user could write a number of orders and create documents and then sign all
items at the same time.
•
Sign selected…enables
users to highlight one or more orders and then sign them. When the dialog
displays, only the selected orders or documents will display for signature.
•
Select New Patient
brings up the signature dialog that includes all unsigned orders for the
current patient before opening another patient record. The orders are broken
into three groups, the user’s orders from this ordering session, the user’s
unsigned orders for the patient from previous ordering sessions, and unsigned
orders for the patient written by other users. The user can then select and
deselect the orders to be signed.
•
Exiting the chart
(closing CPRS) brings up the same dialog as selecting a new patient (see
above).
CPRS provides three methods for signing orders and
documents. You can sign orders and documents together from the Review / Sign
Changes dialog or you can sign orders and documents separately using the Sign
Selected Orders and Sign Documents Now commands.
Electronic Signatures
Most orders or documents, such as progress notes, consults,
or discharge summaries, require an electronic signature. Generally, orders that
require a signature are not released to services or activated until they are
signed.
Note: There are two exceptions to this rule: 1)
orders that can be designated as “signed on chart” and 2) generic orders that
do not require a signature.
To electronically sign an order or a document, a user must
have an electronic signature code, which is created in VistA. If a user does
not have a signature code and needs one, a Clinical Coordinator can assist the
user. As with any password or code that gives access or permission to perform a
task, users must keep their signature codes secret and use it properly to help
keep an accurate medical record.
Digital Signatures
Digital signatures are now required for providers who
prescribe outpatient controlled substance (controlled substance schedules 2-5)
medications. The VA’s implementation of digital signatures for these
medications also allows sites to limit, if needed, which outpatient controlled
substances pharmacy schedules a prescriber has permission to prescribe. Of
course, the site can also allow the provider to write for all schedules.
To digitally sign the controlled substances outpatient
orders requires what is called two-factor authentication, which means that in
addition to entering their electronic signature, the providers must use their
Personal Identification Verification (PIV) cards, card readers attached to
workstations, Personal Identification Numbers (PIN), and digital certificates
to digitally sign the orders.
When the provider attempts to digitally sign the order, CPRS
checks for a valid DEA registration number or VA number for the prescriber and
to see if the provider is authorized to write medications for the specified
pharmacy schedule to which the selected medication belongs.
By digitally signing the controlled substance order, the
prescriber acknowledges and accepts the following as mandated by the DEA:
By completing the two-factor authentication protocol at this time, you
are legally signing the prescription(s) and authorizing the transmission of the
above information to the pharmacy for dispersing. The two-factor authentication
protocol may only be completed by the practitioner whose name and DEA
registration number appear above.
How Does CPRS Show a Digital Signature?
CPRS displays order information in several places where
users will be able to see that an outpatient controlled substance order was
digitally signed.
•
Cover Sheet: If the
order has been digitally signed, the detailed order display from right-clicking
the order on the Cover Sheet where it currently shows “Elec Signature:” will
show “Dig Signature:"
Note: If the provider has an
NPI, it will not display on the screen below.
This graphic is a detailed display
of an order on the CPRS Cover Sheet. Note the text change from “Elec.
Signature,” to “Dig Signature”
•
Orders Tab and Meds Tab:
If the order has been digitally signed, the detailed order display from
right-clicking the order on the Orders tab or from selecting it and choosing
Details from the View menu where it currently shows “Elec Signature:” will show
“Dig Signature:”
Note: If the provider has an
NPI, it will not display on the screen below.
The above graphic shows the detailed
display of an order off the Meds or Orders tab. The text has been changed from
“Elec Signature,” to “Dig Signature”
Reports Tab: On
the Daily Order Summary and Order Summary by a Date Range reports, the
signature type will be Digital. On the Chart Copy Summary report, the indicator
shows that the order was digitally signed.
The
above capture of the Reports tab indicates that the orders shown were digitally
signed
Digitally Signing Orders
VA employees have been given Personal Identification
Verification (PIV) cards to improve security. Digitally signing orders for
controlled substances is one area where providers will use their PIV
cards.
A Personal Identification Number (PIN) controls access to
the smart card. When a user needs to digitally sign an order, the user must be
at a workstation with a card reader and must enter the card’s current PIN.
To sign controlled substances orders, digitally sign the
order by
•
Proceeding with the
normal electronic signature process.
•
Selecting the
controlled substances orders that you want to sign when you see the Smart Card
Required caption above the controlled substances orders. You must select each
order individually.
•
Inserting your PIV
card into the card reader.
•
When prompted,
entering your PIN and clicking OK or
pressing <Enter>.
Understanding Service Connection and Treatment
Factors
Upon electronic signature, providers will need to deal with
the various exemptions for copayment for qualified veterans. To help providers
better understand service connection and treatment factors, the following
information is provided.
Service Connected
The assignment of service connected percentage and
disability code is based on the degree of disability as determined by the
rating board decision following the submission of a claim that a veteran’s
illness or injury was incurred in or aggravated by military service.
An adjunct condition, although not service connected,
is medically determined to be associated with or is aggravating a disease or
condition, which is service connected. A
veteran is eligible to receive treatment for an adjunct condition; however,
because the adjunct is not a condition that is specifically rated, VA can bill
the insurance carrier as well as those veterans responsible for copayments for
treatment provided for the adjunct condition.
A secondary condition is defined as a condition that
has been caused or is the result of a service-connected condition. This condition is also nonservice-connected
and treatment provided is also billable.
It is important that the clinician be aware of the patient’s
service-connected conditions. This
information is available by clicking the patient’s name in the blue square in
the upper left corner in CPRS. It is
also found on the encounter form. If a
patient is being treated for a service-connected condition during a visit, the
provider should check the service-connected box on the encounter form
“yes.”
Compensable service-connected veterans are not charged an
outpatient copayment. However,
nonservice-connected veterans and veterans rated less than 50% service
connected with income above the existing threshold may be charged a medication
copayment if the medication is for a nonservice-connected condition. If the veteran has health insurance, a claim
will be submitted to the insurance carrier for the treatment of nonservice-connected
conditions.
Treatment Factors/Environmental Indicators
The provider must make a clinical decision to determine if
an encounter is for a SC condition or one of a number of special
categories. If the veteran is being
treated during the encounter for a condition that the provider believes is for
SC or a special category, the provider should check “Yes” next to the
appropriate category on the encounter form. The veteran will not be billed for
the encounter if “Yes” is checked.
Medication(s) for one of these conditions should be indicated during the
outpatient medication ordering process.
The veteran will not be charged a copayment for a medication that is for
SC or a special category.
The Special Categories included are:
•
Combat Veteran (CV)
•
Agent Orange (AO)
•
Ionizing Radiation
(IR)
•
Southwest Asia
Conditions (SWAC) – includes Gulf War veterans
•
Shipboard Hazard and
Defense (SHD)
•
Military Sexual Trauma
(MST)
•
Head and Neck Cancer
(HNC), after nasopharyngeal radium treatment in service.
Combat Veteran
Overview of Combat Veteran Status
To qualify for the Combat Veteran (CV) exemption, the
veteran must have served in combat operations after the Gulf War or in combat
against a hostile force after November 11, 1998. In addition, the condition for
which the veteran is treated must be related to that combat, the veteran must
have registered as a combat veteran, and be within two years of separation from
active military service. Finally, the condition must not be already considered
to be service related or that exemption should apply.
Note: The Combat Veteran exemption is valid for two
years from the date of separation from military service, not the registration
date. For example, if a veteran registers for Combat Veteran status 18 months
after the date of his or her separation, the veteran would be eligible for
Combat Veteran exemption for six months only. For further details, see VHA
Directive 2002049, Combat Veterans Are Eligible for Medical Services for
2-Years after Separation from Military Service Notwithstanding Lack of Evidence
for Service Connection.
Combat Veteran Markers
To help users better identify Combat Veteran eligible
patients so that appropriate care and prioritization occur for them, CPRS has
added several items where Combat Veteran status is more clearly shown. This is
especially true in Consults. These markers are shown in various places in CPRS,
such as the Patient Selection screen, the buttons available from any tab, the
Consults dialog and details, the SF-513 form, etc.
•
Patient Selection Screen: When the user selects a patient with Combat Veteran status, CPRS
indicates that patient is a combat veteran by displaying the letters CV and a
date below the normal demographic information on the Patient Selection screen
and above the Save Patient List Settings button. The marker is shown in the
screen capture below surrounded by a red box.
•
New Service Consult/Request Notifications: The lower portion of the Patient Selection screen is the
list of notifications for the user that is logged in. For a new consult or
procedure request for a veteran with Combat Veteran status, the letters CV and
the date display behind the abbreviated patient identifier in the Patient
column. The Combat Veteran notification marker is shown in the above screen
capture outlined in red.
•
Combat Veteran Button and Consult Details: Available from any CPRS tab, the Combat Veteran button
displays the letters CV and the expiration date of Combat Veteran status. The
Button displays when the selected patient has Combat Veteran status. The button
shares space with the Flag button. The Combat Veteran button only displays for
patients with the status, otherwise, the Flag button is whole.
•
To get details, the
user selects the button to display the Combat Veteran Details dialog. See Combat Veteran Details Dialog below.
•
When the user selects
the consults from the tree view, the consults details show in the pane to the
right. In this view, the Combat Veteran status is shown underneath the primary
eligibility.
Note: If the provider has an NPI, it will not display on the screen
below.
•
Combat Veteran Details Dialog: When the user selects the Combat Veteran button, the
Combat Veteran Details dialog displays with the following items:
▪ Service Branch
▪ Status
▪ Separation Date
▪ Expiration Date
▪ OEF/OIF (If the patient served in Operation Enduring
Freedom (OEF) or Operation Iraqi Freedom (OIF)
•
Consult Order Dialog: The
Combat Veteran status and expiration date display near the top of the Consult
Order dialog.
Note: If the provider has an NPI, it will display on the screen
below. See the "National Provider
Identifier (NPI) Display in CPRS" section for an example of an NPI
displaying on a screen.
•
SF-513 Form: Several
changes were made to this form:
▪ At the top of the page on the SF-513, the Combat Veteran
marker displays with the demographic information.
▪ The patient’s name was moved to the top of this form.
▪ When printed, the patient’s identifying information will be
printed at the top of each page.
▪ When printed, a page number will be printed at the bottom
of each page.
Note: If the provider has an NPI, it will not display on the screen
below.
Agent Orange
Agent Orange (AO) is an herbicide that was used in Vietnam
between 1962 and 1971 to remove unwanted plant life that provided cover for
enemy forces. The VA has recognized the
following conditions as associated with but not necessarily caused by exposure
to Agent Orange:
•
AL Amylodosis
•
Diabetes (type 2)
•
Chloracne or other
acne form disease consistent with chloracne (must occur within one year of
exposure to AO).
•
Ischemic Heart Disease
•
Parkinson’s Disease
•
Porphyria cutanea
tarda (must occur within one year of exposure to AO).
•
Acute and subacute
peripheral neuropathy. (For purposes of this section, the term acute and
subacute peripheral neuropathy means temporary peripheral neuropathy that
appears within weeks or months of exposure to an herbicide agent and resolves
within two years of the date of onset.)
•
Numerous cancers:
● Prostate cancer
● Hodgkin’s disease.
● Multiple myeloma.
● Non-Hodgkin’s lymphoma.
● Respiratory cancers (cancer of the lung, bronchus, larynx,
or trachea). (Must occur within 30 years of exposure to Agent Orange.)
● Soft-tissue sarcoma (other than osteosarcoma,
chondrosarcoma, Kaposi’s sarcoma, or mesothelioma).
● Chronic lymphocytic leukemia
Ionizing Radiation
Atomic veterans may have been exposed to ionizing radiation
in a variety of ways at various locations.
Veterans exposed at a nuclear device testing site (the Pacific Islands,
e.g., Bikini, NM, NV, etc.) or in Hiroshima and/or Nagasaki, Japan, may be
included. Atomic veterans with exposure
to ionizing radiation are entitled to receive treatment for conditions for this
exposure. VA has recognized the
following conditions by statute or regulation as being associated with
radiation exposure:
Conditions Associated with Ionizing Radiation:
•
All
cancers/malignancies
•
Posterior subcapsular
cataracts
•
Non-malignant thyroid
nodular disease
•
Parathyroid adenoma
•
Tumors of the brain
and central nervous system
Note: Atomic veterans do not have to receive an
Ionizing Radiation Registry Exam to have these special treatment eligibilities.
Southwest Asia Conditions
Gulf War veterans were exposed to a wide variety of
environmental hazards and potentially harmful substances during their service
in Southwest Asia. These include depleted uranium, pesticides, the anti-nerve
gas pill pyridostigmine bromide, infectious diseases, chemical and biological
warfare agents, and vaccinations (including anthrax and botulinum toxoid), and
oil well free smoke and petroleum products. VA recognizes that there are other
health risk factors encountered by Gulf War veterans. Veterans with service
during the Gulf War are entitled to receive treatment for conditions for this
service
If the treatment provided during the encounter is for an
illness or symptom that may possibly be associated with environmental
contamination this should be indicated on the encounter form or medication
order
Conditions Associated with Southwest Asia Conditions:
•
Persistent fatigue
•
Skin rash
•
Headache
•
Arthralgias/myalgias
•
Sleep disturbance
•
Forgetfulness
•
Joint pain
•
Shortness of
breath/chest pain
•
Feverishness
•
Amyotrophic Lateral
Sclerosis
Shipboard Hazard and Defense
Veterans with conditions recognized by VA as associated with
Project 112/ SHAD, shipboard and land-based biological and chemical testing
conducted by the United States (U.S.) military between 1962 and 1973 are
eligible for enrollment in priority group 6, unless eligible for enrollment in
a higher priority. In addition, veterans receive care at no charge for care and
medications provided for treatment of conditions related to exposure.
Military Sexual Trauma
VA is authorized by law to provide counseling services to
women and men veterans who experienced incidents of sexual trauma while they
served on active duty in the military. This Law defines a sexual trauma as
sexual harassment, sexual assault, rape and other acts of violence. It further
defines sexual harassment as repeated unsolicited, verbal or physical contact
of a sexual nature, which is threatening in nature.
The provider must make a clinical decision to determine if a
visit or medication is for MST. If the
veteran is being treated for any condition during this episode of care that the
provider believes is for MST; the visit should be checked as related on the
encounter form and the medication should be designated as for MST. This will mean that the veteran does not have
to pay a copayment for the visit or the medication.
Head and Neck Cancer
Veterans with cancer of the head and neck and a history of
receipt of Nasopharyngeal (NP) radium therapy are eligible to receive
treatment. There are very specific dates and locations where this activity
occurred. Eligibility for this special class needs to be verified by HAS. (Not
all veterans receiving head and neck cancer treatment fall into this treatment
category.)
During the 1920s, nasopharyngeal (NP) radium therapy was
developed to treat hearing loss caused by repeated ear infections.
Radium-tipped rods were inserted into the nostrils and left in place for
several minutes. Military physicians used NP radium to treat aerotitis media
(barotrauma) in submariners, aviators, and divers. It is estimated that between
8,000 and 20,000 military personnel received NP radium treatments during World
War II and until the 1960s. Veterans also included are those with documentation
of NP radium treatment in active military, naval or air service; those who
served as an aviator in the active military, naval or air service before the
end of the Korean conflict; or underwent submarine training in active naval
service before January 1, 1965. Veterans with exposure to NP radium treatments
are eligible to receive treatment for conditions related head and neck cancer.
If the veteran is being treated for any condition during this
episode of care that is for Head and Neck Cancer; the visit should be checked
as related on the encounter form and the medication should be designated for
Head and Neck Cancer. This will mean that the veteran does not have to pay a
copayment for the visit or the medication.
Camp Lejeune
From the 1950s to the 1980s, people living or working at the
U.S. Marine Corps Base Camp Lejeune (CL), NC, were exposed to drinking water
contaminated with industrial solvents, benzene, and other chemicals. Veterans and family members who served on
active duty or resided at Camp Lejeune for 30 days or more between Aug. 1, 1953
and Dec. 31, 1987 may be eligible for VA health benefits for 15
conditions:
•
Esophageal cancer
•
Breast cancer
•
Kidney cancer
•
Multiple myeloma
•
Renal toxicity
•
Female
infertility
•
Scleroderma
•
Non-Hodgkin's
lymphoma
•
Lung cancer
•
Bladder cancer
•
Leukemia
•
Myelodysplastic
syndromes
•
Hepatic steatosis
•
Miscarriage
•
Neurobehavioral
effects
On August 6, 2012, President Obama signed into law the “Honoring
America’s Veterans and Caring for Camp Lejeune Families Act of 2012” (P. L.
112-154). This law provides health care
for Veterans who served on active duty at Camp Lejeune and reimbursement for
health care to family members who resided at Camp Lejeune for not fewer than 30
days between August 1, 1953 and December 31, 1987. The law authorizes care for
15 medical conditions, even if there is insufficient medical evidence to
conclude that such illnesses or conditions are attributable to the Veterans’
military service or family members’ residence at Camp Lejeune.
Note: The Camp
Lejeune environmental indicator will not be available until the release of
patch OR*3.0*407.
Review / Sign Changes Dialog
The Review / Sign Changes dialog allows you to
simultaneously sign multiple orders and documents at the same time. The
Review/Sign Changes option is under the File menu and brings up a dialog with
the items that need a signature from the current ordering session.
Sometimes during the ordering process, the status of a
patient changes from outpatient to inpatient or vice versa. This might happen
because an outpatient was admitted to the facility or because an inpatient was
sent to a clinic for treatment.
When written unsigned orders exist and the patient’s status
changes, the user must indicate which location the orders are associated with.
To designate which location written unsigned orders are
associated with, the following dialog will appear:
This
dialog asks to which location CPRS should associate the orders that have been
placed but not signed
The order location dialog shows the user the two locations
the user can choose from, generally an outpatient clinic and an inpatient
location. The user has two basic options:
•
Associate all of the
orders with a single location by selecting the appropriate button above the
list of orders. The buttons will read All location where location is the name
of the clinic or ward location. In the above screen capture the buttons read All
MICU and All Mental Health Clinic.
•
Individually associate
each order with one of the two locations. At the end of each order is a column
to select the location for each order.
If the user is keeping the patient’s chart open, such as
selecting File | Review / Sign changes… and this dialog appears, the “Where
would you like to continue processing patient data?” prompt displays enabling
the user to choose either the ward location or the clinic location. This prompt
does not appear if the user is exiting the chart or switching patients.
To sign orders and documents with the
Review / Sign Changes dialog, follow these steps:
1.
Do one of the
following:
o
Select File | Review / Sign Changes....
to sign orders or documents and stay in the current patient record.
o
Choose File | Select New Patient to sign orders or
documents and select a new patient.
o
Choose File | Exit to sign orders and documents and exit CPRS.
2.
(Conditional) This step will only be necessary
if CPRS displays order checks similar to what is shown below:
In this screen capture, CPRS
displays a conflict between ordered medications. Users should review each item
carefully before completing the order. Each order that has a high-level order
check requires you to select that order and an override reason for it. All
orders with an “Action is required” status require an override reason in order
to be signed. These order checks are designated by the “*Checks marked with
**** require reason to override” text in red and the order check text in blue.
The Accept button will not activate until all orders have been viewed, and all
override reasons have been entered as needed.
If CPRS displays order checks,
carefully review the order checks and take the appropriate action below:
a.
To redo the orders to
avoid a possible interaction, select Return to Orders. This will cancel the
signature process, but not the order.
b.
If the orders should
not be placed, check the cancel check box in front of the orders that should
not be placed and select Cancel Checked Order(s).
c.
If the possible
interactions are not a problem, type a reason for override if necessary
(required only for some order checks) and select Continue.
After
performing step 1 and addressing any order checks in step 2, one of the
Review/Sign Changes dialogs shown below will appear. Each item that requires a
signature will have a check box in front of it.
Note: All non-controlled substances orders will be checked for
signature when the dialog displays. To sign controlled substances orders, the
user must check the box for each order individually.
Figure A: This is for providers that
can sign orders by policy, such as nurses or clerks. Note that the default
method for release to service can be set by the site to Verbal, Telephone, or
Policy. Or the site can leave the default blank forcing the user to select the
method.
Note: If the provider has an NPI, it
will not display on the screen below.
Figure B: The Review/Sign changes
dialog may have additional elements depending on the nature of the patient. In
this case, the provider can sign controlled substances orders and the patient’s
conditions are not service-connected
Note: If the provider has an NPI, it will not display on the screen
below.
Figure C: In this example of the
Review/Sign Changes dialog, the provider can sign controlled substance orders,
and the patient has either Combat Veteran status or service-connected
conditions for which the provider must indicate the orders pertain
3.
Deselect any items
under the All Orders Except Controlled Substance Orders pane that you do not
want to sign by clicking the check box to the left of the order or document.
4.
If the Review / Sign
Changes dialog resembles Figure A, enter your electronic signature code and
click Sign. The documents and orders
will now be signed.
If the Review / Sign Changes dialog
resembles Figure B or Figure C and contains question marks, continue to step 5.
5.
To select Controlled
Substance order to sign, place a check mark in the box to the left each
Controlled Substance order to sign by clicking in the check box, or tabbing to
it and pressing the <Space bar>.
Note: When the user checks the box to
the left of any Controlled Substance order for signature, the phrase “SMART
card required” displays next to the label Controlled Substance Orders.
Note: If the provider has an NPI, it will not display on the
screens below.
This is what the dialog looks like
before controlled substance outpatient orders are checked for signature.
After the controlled substances
orders are checked, the “smart card required” text and the text the provider
must acknowledge display
6.
The question marks
inside the boxes in Figure B indicate that you need to specify how that order
is related to the medical condition in that column. (SC = Service Connected
Condition, CV=Combat Veteran, AO=Agent Orange Exposure, IR=Ionizing Radiation
Exposure, SWAC=Southwest Asia Conditions, SHD=Shipboard Hazard and Defense,
MST=Military Sexual Trauma, and HNC=Head or Neck Cancer). If you place a check in a box, you are
indicating that a medication order is related to the condition in that column.
If you create an empty box, you are indicating that the medication order is not
related to the condition in that column.
You must either check or uncheck every box that contains a question mark
before you can sign the order.
Note: Definitions for service connection and treatment factors are
available to users by hovering the cursor over the term or using the
appropriate keyboard shortcut as shown in the list below:
●
Service connection
(SC) ......................... Alt + c
●
Combat Veteran (CV)
............................. Alt + v
●
Agent Orange (AO)
................................. Alt + o
●
Ionizing Radiation
(IR) ............................ Alt + r
●
Southwest Asia
Conditions (SWAC) ....... Alt + a
●
Shipboard Hazard and
Defense (SHD) .. Alt + h
●
Military Sexual Trauma
(MST) ................ Alt + m
●
Head and/or Neck
Cancer (HNC) ........... Alt + n
You can toggle the check boxes by:
●
Clicking an individual
check box.
This will toggle the box between
checked and unchecked.
●
Pressing the
appropriate Copay button
This will toggle all the check
boxes in that column.
●
Pressing the 
button.
This will toggle all the check
boxes on the screen.
7.
If you have not
already done so, insert your PIV or smart card.
Note: If you do not insert
your PIV or smart card before attempting to sign the selected Controlled
Substance orders, you will see the following two dialogs:
8.
When you have removed
all of the question marks from the dialog, enter your electronic signature code
(the button will change from Don’t Sign to Sign) and click Sign.
9.
(Conditional) If your
PIV card is already set up, you will not see the Digital Signing Setup dialog
and you can proceed to step 10. If your PIV or Smart card is not yet linked to
your VistA account, you will need to set it up before you can sign outpatient
controlled substance medication orders. To set up your PIV card to order
outpatient controlled substance orders, select Yes.
Note: If the provider has an NPI, it will not display on the
screens below.
You may then be asked to enter your
PIN
Then, the signature process will
proceed
10.
If the Order Check
dialog appears, deal with any problems in the dialog: such as entering a reason
for override, cancelling specific orders, etc. When ready, select the Accept Orders button.
11.
When prompted, enter
your PIN to sign the Controlled Substance orders and select OK or press
<Enter>.
Warning: Do NOT enter an incorrect PIN five (5) consecutive times!
If you enter the incorrect PIN five (5) consecutive times, your card will be
until you visit a PIV issuing station.
If you
enter the incorrect PIN three (3) times, CPRS temporarily locks your PIV card
for 15 minutes. Then, it will allow you to try again. However, you only have
two (2) more attempts to get the correct PIN. If you get to five (5)
consecutive incorrect PIN entries, the PIV card will be locked and you will
have to go to a PIV station to unlock the card.
Sign Selected Orders Command
The Sign Selected Orders command allows you to select a
number of orders and sign them all simultaneously. However, you cannot sign
documents with this command.
Sometimes during the ordering process, the status of a
patient changes from outpatient to inpatient or vice versa. This might happen
because an outpatient was admitted to the facility or because an inpatient was
sent to a clinic for treatment. When written unsigned orders exist and the
patient’s status changes, the user must indicate which location the orders are
associated with.
To designate which location written unsigned orders are
associated with, the following dialog will appear:
This
dialog asks to which location CPRS should associate the orders that have been
placed but not signed
The order location dialog shows the user the two locations
the user can choose from, generally an outpatient clinic and an inpatient
location. The user has two basic options:
•
Associate All of the
orders with a single location by selecting the appropriate button above the
list of orders. The buttons will read All location
where location is the name of the clinic or ward location. In the above screen
capture, the buttons read All MICU and All Mental Health Clinic.
•
Individually associate
each order with one of the two locations. At the end of each order is a column
to select the location for each order.
If the user is keeping the patient’s chart open, such as
selecting File | Review / Sign changes… and this dialog appears, the “Where
would you like to continue processing patient data?” prompt displays enabling
the user to choose either the ward location or the clinic location. This prompt
does not appear if the user is exiting the chart or switching patients.
To
sign a number of orders, use these steps:
1.
Select the Orders tab.
2.
Highlight the orders you want
to sign.
To select a range of items,
click the order at the beginning of the range; then hold down the <Shift> key and click the order at
the end of the range. To select multiple, individual orders, select the first
order, hold down the CTRL key, and
click the next order.
3.
Select Action | Sign
Selected…
-or-
right-click and select Sign…
4.
(Conditional) This step will
only be necessary if CPRS displays order checks similar to what is shown below:
In
this screen capture, CPRS displays a conflict between ordered medications.
Users should review each item carefully before completing the order. Each order
that has a high-level order check requires you to select that order and select
an override reason for it. All orders with an “Action is required” status
require an override reason in order to be signed. These order checks are
designated by the “*Checks marked with **** require reason for override” text
in red and the order check text in blue.
The Accept button will not activate until all orders have been viewed, and all
override reasons have been entered as needed.
5.
If CPRS displays order
checks, carefully review the order checks and take the appropriate action
below:
a.
To redo the orders to
avoid a possible interaction, select Return to Orders. This will cancel the
signature process, but not the order.
b.
If the orders should
not be placed, check the cancel check box in front of the orders that should
not be placed and select Cancel Checked Order(s).
c.
If the possible
interactions are not a problem, type a reason for override if necessary
(required only for some order checks) and select Continue.
After performing step 1 and addressing any order checks in
step 2, one of the Review/Sign Changes dialogs shown below will appear. Each
item that requires a signature will have a check box in front of it.
Note: All
non-controlled substances orders will be checked for signature when the dialog
displays. To sign controlled substances orders, the user must check the box for
each order individually.
Figure A: This is for providers that
can sign orders by policy, such as nurses or clerks. Note that the default
method for release to service can be set by the site to Verbal, Telephone, or
Policy. Or the site can leave the default blank forcing the user to select the
method.
Note: If the
provider has an NPI, it will not display on the screen below.
Figure
B: The Review/Sign changes dialog may have additional elements depending on the
nature of the patient. In this case, the provider can sign controlled
substances orders and the patient’s conditions are not service-connected
Note: If the
provider has an NPI, it will not display on the screen below.
Figure
C: In this example of the Review/Sign Changes dialog, the provider can sign
controlled substance orders, and the patient has either Combat Veteran status
or service-connected conditions for which the provider must indicate the orders
pertain
Note: If the
provider has an NPI, it will not display on the screen above.
6.
If the Electronic Signature
dialog resembles Figure A, enter your electronic signature code (if necessary)
and select Sign. The orders will now be
signed.
If the Electronic Signature
dialog resembles Figure B or Figure C and contains blue question marks,
continue to step 6.
a.
To select Controlled
Substance order to sign, place a check mark in the box to the left each
Controlled Substance order to sign by clicking in the check box, or tabbing to
it and pressing the <Space bar>.
Note: When the
user checks the box to the left of any Controlled Substance order for
signature, the phrase “SMART card required” displays next to the label
Controlled Substance Orders.
Note: If the
provider has an NPI, it will not display on the screens below.
This
is what the dialog looks like before controlled substance outpatient orders are
checked for signature
After
the controlled substances orders are checked, the “smart card required” text
and the text the provider must acknowledge display
7.
The question marks
inside the boxes in Figure B indicate that you need to specify how that order
is related to the medical condition in that column. (SC = Service Connected
Condition, CV=Combat Veteran, AO=Agent Orange Exposure, IR=Ionizing Radiation
Exposure, Southwest Asia Conditions (SWAC), Shipboard Hazard and Defense (SHD),
MST=Military Sexual Trauma, and HNC=Head and/or Neck Cancer). If you place a check in a box, you are
indicating that a medication order is related to the condition in that column. If
you create an empty box, you are indicating that the medication order is not
related to the condition in that column.
You must either check or uncheck every box that contains a question mark before you can sign the order.
Note: Definitions
for service connection and treatment factors are available to users by hovering
the cursor over the term or using the appropriate keyboard shortcut as shown in
the list below:
●
Service connection
(SC) ......................... Alt + c
●
Combat Veteran (CV)
............................. Alt + v
●
Agent Orange (AO)
................................. Alt + o
●
Ionizing Radiation
(IR) ............................ Alt + r
●
Southwest Asia
Conditions (SWAC) ....... Alt + a
●
Shipboard Hazard and
Defense (SHD) .. Alt + h
●
Military Sexual Trauma
(MST) ................ Alt + m
●
Head and/or Neck
Cancer (HNC) ........... Alt + n
You can toggle the
check boxes by:
● Clicking an individual check box.
This will toggle the box between
checked and unchecked.
● Pressing the appropriate Copay button.
This will toggle all the check
boxes in that column.
● Pressing the button.
This will toggle all the check
boxes on the screen.
8.
To select Controlled
Substance order to sign, place a check mark in the box to the left each
Controlled Substance order to sign by clicking in the check box, or tabbing to
it and pressing the <Space bar>.
Note: When the
user checks the box to the left of any Controlled Substance order for
signature, the phrase “SMART card required” displays next to the label
Controlled Substance Orders.
9.
If you have not already done
so, insert your PIV or smart card.
Note: If you do not insert your PIV or smart card
before attempting to sign the selected Controlled Substance orders, you will
see the following two dialogs:
10. When you have removed all of the question marks from the
dialog, enter your electronic signature code (the button will change from Don’t
Sign to Sign) and click Sign.
11. (Conditional) If your PIV card is already set up, you will
not see the Digital Signing Setup dialog and you can proceed to step 11. If
your PIV or Smart card is not yet linked to your VistA account, you will need
to set it up before you can sign outpatient controlled substance medication
orders. To set up your PIV card to order outpatient controlled substance
orders, select Yes.
b.
Note: If the provider
has an NPI, it will not display on the screens below.
You
may then be asked to enter your PIN
Then,
the signature process will proceed
12. If the Order Check dialog appears, deal with any problems
in the dialog: such as entering a reason for override, cancelling specific
orders, etc. When ready, select the Accept Orders button.
13. When prompted, enter your PIN to sign the Controlled
Substance orders and select OK or press <Enter>.
Warning: Do NOT
enter an incorrect PIN five (5) consecutive times! If you enter the incorrect
PIN five (5) consecutive times, your card will be until you visit a PIV issuing
station.
If you enter the
incorrect PIN three (3) times, CPRS temporarily locks your PIV card for 15
minutes. Then, it will allow you to try again. However, you only have two (2)
more attempts to get the correct PIN. If you get to five (5) consecutive
incorrect PIN entries, the PIV card will be locked and you will have to go to a
PIV station to unlock the card.
Signing Orders before Selecting a New Patient or
Exiting CPRS
Whenever a user leaves a patient chart whether to select a
new patient or to exit CPRS completely, CPRS prompts the user to sign unsigned
orders that the user has privileges to sign. The dialog that CPRS displays may
be different than the Review/Sign Changes… or Sign Selected dialogs based on
the parameter settings. By changing the parameters settings, the dialog may
display one or more of the following categories of unsigned orders:
● My Unsigned Orders - This Session
● My Unsigned Orders - Previous Sessions
● Others’ Unsigned Orders - All Sessions
Sometimes during the ordering process, the status of a
patient changes from outpatient to inpatient or vice versa. This might happen
because an outpatient was admitted to the facility or because an inpatient was
sent to a clinic for treatment. When written unsigned orders exist and the
patient’s status changes, the user must indicate which location the orders are
associated with.
To designate which location written
unsigned orders are associated with, the following dialog will appear:
This
dialog asks to which location CPRS should associate the orders that have been
placed but not signed
The order location dialog shows the user the two locations
the user can choose from, generally an outpatient clinic and an inpatient
location. The user has two basic options:
● Associate All of the orders with a single location by
selecting the appropriate button above the list of orders. The buttons will
read All location where location is
the name of the clinic or ward location. In the above screen capture the
buttons read All MICU and All Mental Health Clinic.
● Individually associate each order with one of the two
locations. At the end of each order is a column to select the location for each
order.
If the user selects File | Review / Sign changes… and this
dialog appears, the “Where would you like to continue processing patient data?”
prompt displays enabling the user to choose either the ward location or the
clinic location. This prompt does not appear if the user is exiting the chart
or switching patients.
To sign a number of
orders, use these steps:
- Select the Orders tab.
- Highlight the orders you want to sign.
To select a range of items,
click the order at the beginning of the range; then hold down the <Shift> key and click the order at
the end of the range. To select multiple, individual orders, select the first
order, hold down the CTRL key, and
click the next order.
- Select Action | Sign Selected…
-or-
right-click and select Sign…
- (Conditional) This
step will only be necessary if there are conflicts with the orders, as
shown below:
In
this screen capture, CPRS displays conflicts between ordered medications. Users
should review each item carefully before completing the order. If an order
check is larger than the cell’s available space, the user can either hover with
the mouse to the get the full text, use the arrow keys to highlight the order
check if using the keyboard or use an accessibility product for the visually
challenged. Some order checks require an
override reason. These order checks are designated by the “*Order Check requires
Reason for Override” text in red and the order check text in blue.
If CPRS displays order checks, carefully review the order
checks and take the appropriate action below:
a.
To redo the orders to
avoid a possible interaction, select Return to Orders. This will cancel the
signature process, but not the order.
b.
If the orders should
not be placed, check the cancel check box in front of the orders that should
not be placed and select Cancel Checked Order(s).
c.
If the possible
interactions are not a problem, type a reason for override if necessary
(required only for some order checks) and select Continue.
After performing step 1 and addressing any order checks in
step 2, one of the Review/Sign Changes dialogs shown below will appear. Each
item that requires a signature will have a check box in front of it.
Note: All
non-controlled substances orders will be checked for signature when the dialog
displays. To sign controlled substances orders, the user must check the box for
each order individually.
One of the Electronic Signature dialog boxes shown below
will appear.
Figure A: This is for providers that
can sign orders by policy, such as nurses or clerks. Note that the default
method for release to service can be set by the site to Verbal, Telephone, or
Policy. Or the site can leave the default blank forcing the user to select the
method.
Figure
B: The Review/Sign changes dialog may have additional elements depending on the
nature of the patient. In this case, the provider can sign controlled
substances orders and the patient’s conditions are not service-connected
Note:
If the provider has an NPI, it will not display on the screen above.
Figure
C: In this example of the Review/Sign Changes dialog, the provider can sign
controlled substance orders, and the patient has either Combat Veteran status
or service-connected conditions for which the provider must indicate the orders
pertain
Note: If the
provider has an NPI, it will not display on the screen above.
- If the Electronic Signature dialog
resembles Figure A, enter your electronic signature code (if necessary)
and click Sign. The orders will now
be signed.
- If the Electronic Signature dialog
resembles Figure B and contains checkboxes, continue to step To select
Controlled Substance order to sign, place a check mark in the box to the
left each Controlled Substance order to sign by clicking in the check box,
or tabbing to it and pressing the <Space bar>.
Note:
When the user checks the box to the left of any Controlled Substance order for
signature, the phrase “SMART card required” displays next to the label
Controlled Substance Orders.
This
is what the dialog looks like before controlled substance outpatient orders are
checked for signature
After
the controlled substances orders are checked, the “smart card required” text
and the text the provider must acknowledge display
Note:
If the provider has an NPI, it will not display on the screen above.
- The question marks inside the check boxes
in Figure B indicate that you need to specify how that order is related to
the medical condition in that column. (SC = Service Connected Condition,
CV=Combat Veteran, AO=Agent Orange Exposure, IR=Ionizing Radiation
Exposure, Southwest Asia Conditions (SWAC), Shipboard Hazard and Defense
(SHD), MST=Military Sexual Trauma, and HNC=Head and/or Neck Cancer). If you place a check in a box, you are
indicating that a medication order is related to the condition in that column.
If you create an empty box, you are indicating that the medication order
is not related to the condition in that column. You must either check or uncheck every
box that contains a question mark before you can sign the order.
Note: Definitions
for service connection and treatment factors are available to users by hovering
the cursor over the term or using the appropriate keyboard shortcut as shown in
the list below:
● Service connection (SC) ......................... Alt + c
● Combat Veteran (CV) ............................. Alt + v
● Agent Orange (AO) ................................. Alt + o
● Ionizing Radiation (IR) ............................ Alt +
r
● Southwest Asia Conditions (SWAC) ....... Alt + a
● Shipboard Hazard and Defense (SHD) .. Alt + h
● Military Sexual Trauma (MST) ................ Alt + m
● Head and/or Neck Cancer (HNC) ........... Alt + n
You can toggle the check boxes by:
● Clicking an individual check box.
This will toggle the box between checked and unchecked.
● Pressing the appropriate Copay button.
This will toggle all the check boxes in that column.
● Pressing the button.
This will toggle all the check boxes on the screen.
c.
To select Controlled
Substance order to sign, place a check mark in the box to the left each
Controlled Substance order to sign by clicking in the check box, or tabbing to
it and pressing the <Space bar>.
Note: When the
user checks the box to the left of any Controlled Substance order for
signature, the phrase SMART card required displays next to the label Controlled
Substance Orders.
d.
If you have not
already done so, insert your PIV or smart card.
Note: If you
do not insert your PIV card before attempting to sign the selected Controlled
Substance orders, you will see the following two dialogs:
- When you have removed all of the question
marks from the dialog, enter your electronic signature code (the button
will change from Don’t Sign to Sign) and click Sign. (Conditional) If your PIV card is
already set up, you will not see the Digital Signing Setup dialog and you
can proceed to step 11. If your PIV or Smart card is not yet linked to
your VistA account, you will need to set it up before you can sign
outpatient controlled substance medication orders. To set up your PIV card
to order outpatient controlled substance orders, select Yes.
Note: If the
provider has an NPI, it will not display on the screens below.
You may then be asked to enter your PIN.
Then, the signature process will proceed.
- If the Order Check dialog appears, deal
with any problems in the dialog: such as entering a reason for override,
cancelling specific orders, etc. When ready, select the Accept Orders
button.
- When prompted, enter your PIN to sign the
Controlled Substance orders and select OK or press <Enter>.
Warning: Do NOT
enter an incorrect PIN five (5) consecutive times! If you enter the incorrect
PIN five (5) consecutive times, your card will be until you visit a PIV issuing
station.
If you enter the
incorrect PIN three (3) times, CPRS temporarily locks your PIV card for 15
minutes. Then, it will allow you to try again. However, you only have two (2)
more attempts to get the correct PIN. If you get to five (5) consecutive
incorrect PIN entries, the PIV card will be locked and you will have to go to a
PIV station to unlock the card.
Criteria Used to Determine if the Service Connection
and Treatment Factor Buttons are Displayed in the Review/Sign Changes Dialog
The Review/Sign Changes dialog may contain the service
connection and treatment factor (formerly called the “Copay”) buttons 
if the current patient has outpatient
medication orders that need to be signed and certain additional conditions are
met. The additional conditions are explained below.
Note: These
buttons will not display until after December 31, 2001 and PSO*7*71 is released
and installed.
•
To qualify for the
Combat Veteran (CV) exemption, the veteran must have served in combat
operations after the Gulf War or in combat against a hostile force after
November 11, 1998. In addition, the condition for which the veteran is treated
must be related to that combat, the veteran must have registered as a combat
veteran, and be within two years of separation from active military service.
Finally, the condition must not be already considered to be service related or
that exemption should apply.
Note: The Combat Veteran
exemption is valid for two years from the date of separation from military
service, not the registration date. For example, if a veteran registers for
Combat Veteran status 18 months after the date of his or her separation, the
veteran would be eligible for Combat Veteran exemption for six months only. For
further details, see VHA Directive
2002-049, Combat Veterans Are Eligible for Medical Services for 2-Years after
Separation from Military Service Notwithstanding Lack of Evidence for Service
Connection. If a patient is a veteran and
50% service connected or greater,
then the Copay buttons will not be displayed on the Review / Sign Changes
dialog.
•
If a patient is a
veteran and 50% service connected or greater, then the Copay buttons will
not be displayed on the Review / Sign Changes dialog.
•
If a patient is a
veteran and less than 50% service
connected and the patient is exempt
from copay then the Copay buttons
will not be displayed.
•
If a patient is a
veteran and less than 50% service
connected, and the patient is not exempt from copay then the Pharmacy
package checks to see if the drug specified in the medication order is marked
as supply or investigational. If the drug is marked as supply or
investigational, the Copay buttons will not appear.
However, if the drug specified in
the order is not marked as supply or investigational,
then CPRS checks if the patient has any other exemptions (Service Connected
Condition, Combat Veteran, Agent Orange Exposure, Ionizing Radiation Exposure,
Southwest Asia Conditions, Shipboard Hazard and Defense, Head and/or Neck
Cancer or Military Sexual Trauma). If a patient has any of these exemptions,
then CPRS displays the buttons.
The Sign Note Now and Sign Discharge Summary Now
Commands
The Sign Note Now and Sign Discharge Summary Now menu items
let you sign the currently selected note or discharge summary.
Note: Notes and
discharge summaries cannot be altered once they are signed.
To sign a note or discharge summary, use these steps:
1.
Select the Notes or
DC/Summ tab.
2.
Select the note or
discharge summary that you would like to sign.
3.
Select Action | Sign
Note Now (or Sign Discharge Summary Now).
-or-
right-click in the document area
and select Sign Note Now (or Sign Discharge Summary Now).
4.
Type in your
electronic signature code.
5.
Select OK.
Add to Signature List
With the Add to Signature List command, you can place notes
or discharge summaries for the same patient on a list where you can
simultaneously sign them.
To add a note or discharge summary to your signature list,
follow these steps:
1.
Click the Notes or DC/Summ tab.
2.
Select the note or
discharge summary that you would like to add to your signature list.
3.
Choose Action | Add to
Signature List.
The note or discharge summary will
be added to your signature list. To sign all of the notes or discharge
summaries on your signature list select File
| Review / Sign Changes.
Viewing Unsigned Notes or Discharge Summaries
With the View Unsigned Notes or View Unsigned Discharge
Summaries command you can view all the notes and discharge summaries that you
have not yet signed.
To view unsigned notes or discharge
summaries, follow these steps:
1.
Click the Notes or DC/Summ tab.
2.
Select either View |
Unsigned Notes, View | Uncosigned Notes, View | Unsigned Summaries or View | Uncosigned Summaries.
The unsigned notes or discharge
summaries will appear in the detail portion of the window.
Identify Additional Signers
With the Identify Additional Signers feature, you can select
other individuals that you want to sign a note or discharge summary. Once you
have selected the additional signers, CPRS will send them an alert that
indicates a note is ready for them to sign.
The Identify Additional Signers feature helps you ensure
that team members see a note. For example, one psychiatrist might identify
another psychiatrist to sign the note to ensure that he or she agrees with an
assessment.
To identify
additional signers, use these steps:
1.
Select the Notes or DC/Summ tab.
2.
Select a signed note
or discharge summary.
3.
Select Action |
Identify Additional Signers
-or-
right-click in the main text area
and select Identify Additional Signers.
4.
To identify a signer,
locate the person’s name (scroll or type in the first few letters of the last
name) and click it.
Note: For a Discharge
Summary, if a user requires a cosigner (such as a student or other type of
clinician), that user’s name should not appear in the list of potential
cosigners. Additionally, for all types of documents, to help users distinguish
between providers, CPRS displays their titles (if available). When two or more
providers have identical names, CPRS also displays:
o
The service/section
and site division (if any) associated with these providers; site divisions are
displayed based on the following rules:
▪ When no division is listed for a provider, no division is
displayed.
▪ If only one division is listed, this division is displayed.
▪ If the site has multiple divisions or more than one
division is listed and one of these
listed divisions is marked as Default, CPRS displays the division marked as
Default.
▪ If more than one division is listed for a provider and none
is marked as Default, CPRS does not display division information for this
provider.
o
Providers who are
listed in the New Person file as Visitors are screened out from the provider
list. (These screened-out providers are listed as Visitors because their
entries were created as a result of a Remote Data View.)
5.
Repeat step 4 as
needed.
6.
(Optional) To remove a
name highlight the name under Current Additional Signers and select Remove.
7.
When finished, select OK.
Printing from
Within CPRS
You can print most reports, notes, and detailed displays
from within the CPRS GUI.
To print graphics and charts, you will need to print to a
Windows printer. To print text documents, you can print to either a Windows
printer or a VistA printer. The printer language used by Windows printers can
accommodate graphics, while the language used by VistA printers cannot.
Printing Single Items
You can also print graphics on a Windows printer from the
Labs tab and the Vitals screen. You can use File | Print Setup... to set the preferred attributes for the
printer. CPRS remembers which printer you used last and will print to that
printer again unless you changed it for the duration of the session. You can
also configure and save a printer as the default for the user.
The dialog box shown below opens when you select File | Print from the Notes tab. A
similar dialog appears for items on other tabs.
The
Report Print Device Selection dialog
Normally, the right margin and page length values (measured
in characters) are already defined by the printer.
Printing Multiple Notes, Consults, or Discharge
Summaries
The ability to print multiple Progress Notes, Consults, and
Discharge Summaries has been added to the CPRS GUI. This feature is available
from those tabs only.
To print multiple Notes, Consults, or Discharge Summaries,
use these steps:
1.
Go to the appropriate
tab (Notes, Consults, or DC/Summ) by clicking on the tab or using the keyboard
commands to locate the tab.
2.
Select File | Print Selected Items… to bring
up the dialog shown below.
This graphic shows a number of
Progress Notes that can be printed and several highlighted
3.
Select the documents
you want to print.
Note: To select a number of items in a row, click the first item,
hold down the Shift key, and click the last item. All items in the range will
be selected. To select multiple items that are not in a row, click one, hold
down the Control key, and click the other specific notifications.
4.
Select OK.
The Tools menu allows you to quickly access other
applications and utilities from within CPRS. Depending on the configuration of
your site, the Tools menu may allow you to access other VistA applications such
as VistA Imaging or connect you to third-party applications such as
word-processing programs or Internet browsers. Talk to your clinical
coordinator if you wish to add an application or utility to the Tools menu.
At the request of sites, CPRS added the ability to create
nested or submenus (menus within menus) to help them organize the items that
sites place on their Tools menus. The number of items was increased to 99 total
items (including items and separator lines). Again, these items are placed on
the menu and organized by a Clinical Application Coordinator (CAC) or someone
with a similar role at your site.
The Tools menu also contains two standard menu items: Lab
Test Information and Options… These menu items are explained below.
The MyHealthevet Veteran Health Library (VHL) is the
first item listed under the CPRS Tools menu. Selecting this link takes the user
to the MyHealtheVet Veteran Health
Library web site.
Lab Test
Information
The Lab Test Information menu option displays information
about various lab tests.
To display lab test
information:
1.
Select Tools | Lab
Test Information.
The Lab Test
Description dialog will display.
The Lab Test Description dialog
2.
Select a lab test from
the panel on the left side of the dialog.
A description of the lab test you
selected will be displayed in the right side of the dialog.
Options
You can change many of the settings that control the way
CPRS works. The Options choice on the Tools menu contains dialogs that allow
you to change which notifications and order checking messages you get, manage
team and personal lists, assign your default patient selection settings, and
modify your default tab preferences. To access the personal preferences
settings, click Tools | Options from
any CPRS tab.
The Options dialog consists of a number of tabs, each of
which allows access to a category or type of preference settings.
The Tools | Options dialog
General Tab
The General tab includes the Date Range Defaults…button which allows you to limit the date range
for lab results as well as appointments and visits that appear on the cover
sheet, the Clinical Reminders…
button which allows you to configure and arrange which clinical reminders are
displayed on the cover sheet, and the Other
Parameters…button which allows you to set which tab is active when CPRS
starts, set the date range for items on the Meds tab, and set the date range
for Encounter appointments. The buttons on the General tab are explained in
more detail below.
Date Range Defaults…
Click Date Range
Defaults… to set how long lab results, appointments, and visits will be
displayed on the Cover Sheet.
The
Date Range Defaults on Cover Sheet dialog allows you to set the default date
range for lab results and appointments and visits
Clinical Reminders…
Click Clinical
Reminders… to configure and arrange which clinical reminders are displayed
on the Cover Sheet.
Based on the setting of the parameter ORQQPX NEW REMINDER
PARAMS, you see one of two dialogs for configuring and arranging clinical
reminders on your coversheet. If this parameter is set to “Off,” you will see
the “Clinical Reminders on Cover Sheet” dialog. If the parameter is set to
“On,” you will see the “Clinical Reminders and Reminder Categories Displayed on
Cover Sheet” dialog. Your Clinical Coordinator sets the ORQQPX NEW REMINDERS
PARAMS parameter.
Clinical Reminders on Cover Sheet
To select the
clinical reminders you want displayed on the Cover Sheet, follow these steps:
1.
From the Clinical
Reminders on Cover Sheet dialog, highlight an item in the “Reminders not being
displayed:” field.
2.
Select the arrow
button ( > ) to add the clinical reminder
to the “Reminders being displayed:” field. (Hold down the control key to select
more than one reminder at a time.) The reminders in this field will be
displayed on the Cover Sheet. Select the arrow button ( > ) to remove an item.
3.
To control how the
reminders are displayed on the Cover Sheet, do one of the following:
o
click the “Display Order” option (at the bottom of
the dialog) to display the reminders in their current order. To move a reminder
up or down the list, select the reminder and click either the up or down arrow.
o
click the
“Alphabetical” option (at the bottom of the dialog) to display the reminders in
alphabetical order.
Clinical Reminders on Cover Sheet
dialog
Clinical Reminders and Reminder Categories Displayed on Cover Sheet
This advanced dialog displays reminders in a way that allows
the user to better manage the reminders that are displayed on the Cover Sheet.
The dialog consists mainly of three large list fields. The “Cover Sheet
Reminders (Cumulative List)” field displays selected information on the
Reminders that will be displayed on the
Cover Sheet. The “Available Reminders & Categories”
field lists all available reminders and serves as a selection list. The “User
Level Reminders” field displays the reminders that you have added to or removed
from the cumulative list. You may sort the reminders in the “Cover Sheet
Reminders (Cumulative List)” field by clicking any of the column headers. Click
the Seq (Sequence) column header to
view the reminders in the order in which they will be displayed on your Cover
Sheet.
An icon legend is displayed to the right of the “Cover Sheet
Reminders (Cumulative List)” field. A folder icon represents a group of
Reminders while a red alarm clock represents an individual Reminder. A Reminder
with a plus sign in the first column has been added to the list while a
Reminder with a minus sign in the first column has been removed from the list.
The user cannot remove reminders with a padlock icon in the first column.
The
Clinical Reminders and Reminder Categories Displayed on Cover Sheet dialog
Cover Sheet Reminders (Cumulative List)
The Level column of the “Cover Sheet Reminders (Cumulative
List)” field displays the originating authority of the Reminder, which can
include System, Division, Location, User Class, and User. Reminders on this
list that display a small gray padlock icon at the beginning of the line cannot
be removed. These Reminders are mandatory. The Seq (Sequence) column defines
the order in which the Reminders will be displayed on the Cover Sheet. If there
are two or more Reminders with the same sequence number, the Reminders will be
listed by level (System, Division, Service, Location, User class, User).
Location shown in Cumulative List
Select this drop-down box and select a location. The
Reminders assigned to that location appear on the Cumulative List.
Available Reminders & Categories
This field displays all of the Reminders and Categories
available to the user. Notice that the reminder name is in parentheses after
the print name. Categories are groups of related Reminders that can be added as
a group. Individual reminders within a category can be removed from the User
Level Reminders field. Highlight a Reminder or Category from the field and
click the right arrow to add them to the User Level Reminders field.
User-Level Reminders
This field displays all of the Reminders selected by the
user. To add a Reminder to your User Level Reminders, highlight the desired
Reminder in the Available Reminders & Categories field and click the right
arrow button. To delete a Reminder from your User Level Reminders field,
highlight the Reminder in the User Level Reminders field and click the left
arrow.
You may determine the order in which the Reminders will be
displayed on the Cover Sheet by changing the Reminder’s sequence number. For
example, to place a Reminder at the top of the Reminders list, assign it a
number less than 10. To change the order of User Level Reminders, highlight
Reminders and click the up arrow or down arrow until the desired order is
achieved.
You may remove any or all non-mandatory Reminders assigned
at any level by adding the Reminder to your User Level and then selecting the Remove button.
Cover Sheet Reminders
Once you have the cumulative list, as you want it, select View Cover Sheet Reminders to view how
the reminders will be displayed on your Cover Sheet for the specified
locations.
The
Cover Sheet Reminders dialog
Once you have made all of the desired changes to the
Reminders that will be displayed on the Cover Sheet, select OK.
Other Parameters…
To set the initial chart tab, Meds tab date range, or
Encounter date range preferences select Other
Parameters.
Chart Tabs
Select the drop-down field and select the chart tab with
which CPRS should open. Select the check box if you want CPRS to remain on the
last selected tab when you change patients.
The
Other Parameters dialog
Note: For this
change to take effect, you must exit CPRS and log back in.
Meds Tab Date Ranges
There are three date ranges that can be configured for the
Meds tab:
● Overall Meds
Default: Default date range for the Meds
tab. It is used if no date range is defined for Inpatient Meds or
Outpatient/Non-VA Meds
● Inpatient Meds: Date range for inpatient medications. If no date range is
defined for Inpatient Meds, the Overall Meds Default date range will be used.
● Outpatient /
Non-VA Meds: Date range for outpatient and
non-VA medications. If no date range is defined for Outpatient/Non-VA Meds, the
Overall Meds Default date range will be used for outpatient and non-VA
medications.
To enter the Meds Tab
date ranges, perform the following steps:
- Enter a State Date by doing one of the following:
•
Typing a date (e.g.
6/21/01 or June 21, 2001).
•
Typing a date formula
(e.g. t-200).
•
Pressing the 
button to bring up a calendar and select a
date.
Note: In most cases, users
should use relative dates, such as T and T-120, when entering them in the Tools | Options dialog. If the user
enters specific dates, they will remain even if the user changes patients.
Specific dates will not change until the user changes them.
- Enter a Stop Date by doing one of the following:
•
Typing a date (e.g.
6/21/01 or June 21, 2001).
•
Typing a date formula
(e.g. t-200).
•
Pressing the button to bring up a calendar and select a
date.
- When you have entered the dates, go to
another option on this dialog or select OK.
Encounter Appointments Date Range
This option enables users to set the date range for
Encounter appointments that CPRS displays on the Cover Sheet and the Encounter
form. The two values are based on today’s date and represent how many days in
the past and how many days in the future the user may set for CPRS to display
appointments.
To set these values, use the following steps:
1.
In the Start Date
field, type or use the arrows to select a number of days in the past CPRS
should display appointments.
2.
In the Stop Date
field, type or use the arrows to select a number of days in the future CPRS
should display appointments.
Note: Your site can set a
parameter to give you a warning if you select an appointment too far in the
future. CPRS will display a warning to let you know that you may be going
against local policy. This message is just a warning and you may proceed.
3.
When you have entered
the dates, go to another option on this dialog or select OK.
Notifications Tab
This tab allows you to change your notification options.
Click the check box if you wish to have MailMan send you a bulletin for flagged
orders.
The Notifications tab
Remove Pending Notifications…
Please use care when using this button to remove pending
notifications, especially if you are designated as a surrogate for another
user, as patient care may be delayed until the original provider returns.
To remove pending
notifications, if necessary, use the following steps:
- Select the Remove Pending Notifications button and then on Yes on the Warning dialog to clear
all of your current pending notifications. (This button is enabled only if
you are authorized to use it.)
- If you are sure you want to remove the
pending notifications, select Yes.
Display Sort
Click the Display
Sort drop-down field to select the sort method for your notifications.
Choices include Patient, Type, and Urgency.
Notifications list
Click the check box next to any notification to enable or
disable it. Notifications with “Mandatory” in the Comment column cannot be
turned off or disabled. Click the heading to sort notifications so that you can
see which are turned on and which are turned off.
WARNING: When a provider is identified as a surrogate
for another user for a designated period of time, notifications from the
original user are sent to the surrogate. If a surrogate user chooses to use this button to remove pending
notifications, all alerts are deleted, even if they are for actions such as
requiring signature. The alerts are deleted not only for the surrogate but also
the user they are a surrogate for. The alerts are permanently deleted for the
surrogate, never to be regenerated, even if they have not been processed.
However, if the alerts have not been processed by the surrogate, some may be
returned to the original user based on a certain set of rules implemented in
the Kernel.
The following are the set of rules. When the surrogacy
period expires and unprocessed surrogate alerts have not been returned yet, the
alerts sent to the surrogate(s) for the user are checked.
▪ If the surrogate has processed an alert, it is
ignored.
▪ If the surrogate has not processed an alert originally
intended for the user, it is returned to the originally intended
recipient.
▪ If the unprocessed alert was also sent to the surrogate as
an initial recipient, then the alert is also retained by the surrogate.
▪ If the alert was forwarded
to the surrogate, but meant only to be
sent to the original user, then the alert is electronically removed from
the surrogate’s notification list.
▪ Any unprocessed alerts that are retained by the surrogate will
require manual intervention to remove them.
There is no difference in how informational vs. action
notifications are managed with respect to surrogacy. The above rules are
applicable regardless of the type of notification.
Order Checks Tab
Click the check box next to any order check to enable or
disable it. Order checks with “Mandatory” in the Comment column cannot be
turned off or disabled. Click the heading to sort order checks so that you can
see which are turned on and which are turned off.
This dialog indicates that the Duplicate Drug Order check is
mandatory and cannot be turned off
Lists/Teams Tab
The Lists/Teams tab allows you to set defaults for selecting
patients. It also contains your personal lists and the teams of which you are a
member.
The Lists/Teams tab
Patient Selection Defaults…
Click Patient Selection Defaults… to change your defaults for selecting
patients. Click a radio button in the List Source group. If you select
Combination, you will be able to select from more than one source. After
selecting a list source, click the appropriate drop-down button (or buttons if
Combination is selected) and select the criteria for that source. If you select
Clinic or if Clinic is one of the sources in your combination of sources, you
will need to select a clinic for each applicable day of the week. If you do not
work in any clinic on a particular day, leave the field for that day empty.
Click a radio button in the Sort Order group to determine
the sort order for the patients. If an item is dimmed, it is not available with
the list source(s) you have selected.
To display patients who have clinic appointments within a
specific date range, click the selection buttons. The Start and Stop fields
denote the number of days before or after today that appointments should be
displayed.
The defaults that are set here are used when you select
patients from the Patient Selection dialog in the CPRS chart. Therefore, if you
choose Ward, it will display the patients for the ward you have set as your
default and if you choose Clinic, it will display the clinic patients for that
day.
Source Combinations…
Click Source
Combinations… to edit or create a list of sources from which your patients
can be selected. You can change your combinations by adding or removing
specific wards, clinics, providers, specialties or lists.
To create a source combination:
- Click a radio button in the “Select source by” group.
- Click an entry in the selection field below the “Select source by”
group.
- Click Add.
- Repeat steps 1 through 3 for each desired source.
- When all desired entries are in the
Combinations field, click OK.
You can create only one combination list. The Combination
list can be set as your default using the Patient Selection dialog.
The
Source Combinations dialog
Personal Lists…
This option allows you to edit your personal lists of
patients or combinations of wards, clinics, providers, specialties, or lists.
Note: If the
provider has an NPI, it will display on the screen below. See the "National Provider Identifier
(NPI) Display in CPRS" section for an example of an NPI displaying on a
screen.
The
Personal Lists dialog allows you to create a personalized patient list
To create a personal
list, use these steps:
1.
Select Personal Lists... to edit or create
list of patients.
2.
To create a list,
select New List...
3.
In the New Personal
List dialog, type in a name for your list. Then, indicate whether the list will
by visible only to you by selecting the Myself only radio button or allow all
users to see the list by selecting the All CPRS users radio button.
4.
Locate the appropriate
patients by selecting the appropriate category under the “Select patients by”
group: Patient, Ward, Clinic, Provider, Specialty, Other.
When a category is selected, CPRS
displays the items for the category. For example, if you choose Clinic, CPRS
displays the list of clinics.
5.
Select the item within
the category that you want to use. For example, if you have a patient and you
know the patient is in a specific clinic, select that clinic.
6.
The Patients to add
field lists all of the patients that can be added from the particular selection
method. Highlight the patient names in this field and click Add (which moves
the highlighted patient or patients into the Patients on Personal List pane. To
add all patients, select Add All to copy all the patients under the Patient to
add pane.
7.
Repeat steps 4-6 until
you have added all the patients you want to your new personal list.
8.
Review the list. If
changes need to be made, use the steps 4-6 to add new names. To remove names,
highlight them under the Patients on Personal List pane and select Remove. To
remove all the names under Patients on Personal List pane, select Remove All.
9.
If needed, select
whether the list should be for Myself only or for All CPRS users.
10.
When you have all the
patients that you want on the list, select Save Changes if you plan to make
other changes on the Personal List dialog such as creating one or more
additional Personal Lists. If you are finished creating personal lists for now,
select OK.
To edit a personal
list, use these steps:
1.
On the Lists/Team tab,
select Personal Lists….
2.
In the Personal Lists
dialog, select the list under the Personal Lists pane that you want to edit.
3.
To add patients to the
list, locate the appropriate patients by selecting the appropriate category
under the “Select patients by” group: Patient, Ward, Clinic, Provider,
Specialty, Other.
When a category is selected, CPRS
displays the items for the category. For example, if you choose Clinic, CPRS
displays the list of clinics.
4.
Select the item within
the category that you want to use. For example, if you have a patient and you
know the patient is in a specific clinic, select that clinic.
5.
The Patients to add
field lists all of the patients that can be added from the particular selection
method. Highlight the patient names in this field and click Add (which moves
the highlighted patient or patients into the Patients on Personal List pane. To
add all patients, select Add All to copy all the patients under the Patient to
add pane.
6.
Repeat steps 3-5 until
you have added all the patients you want to your new personal list.
7.
Review the list. If
changes need to be made, use the steps 3-5 to add new names. To remove names,
highlight them under the Patients on Personal List pane and select Remove. To
remove all the names under Patients on Personal List pane, select Remove All.
8.
If needed, select
whether the list should be for Myself only or for All CPRS users.
9.
When you have all the
patients that you want on the list, select Save
Changes if you plan to make other changes on the Personal List dialog such
as creating one or more additional Personal Lists. If you are finished creating
personal lists for now, select OK.
Teams Information…
This option allows you to view the teams you are on and the
patients associated with those teams.
Note: If the
provider has an NPI, it will not display on the screen below.
The
Team Information dialog
Click a team to view the patients associated with it and
other team members. Click the check box to include your personal lists. Click Remove yourself from this team to
remove yourself from the highlighted team. Click the drop-down button on the
“Subscribe to a team” field and select a team to which you wish to be added.
You can only subscribe yourself to or remove yourself from teams that have been
defined as "subscribable."
Notes Tab
The Notes tab
Notes…
This option on the Notes tab allows you to configure
defaults for editing and saving notes. Click the selection arrows to change the
number of seconds between auto save intervals. You may also assign a default
cosigner for notes by clicking the drop-down button and selecting a provider.
You may also click either of the two check boxes, if you wish to be prompted
for a subject for progress notes and if you wish to verify note titles.
Note: If the
provider has an NPI, it will display on the screen below. See the "National Provider Identifier
(NPI) Display in CPRS" section for an example of an NPI displaying on a
screen.
The
Notes dialog
Document Titles…
You may select a personal list of document titles to be
displayed for several different types of documents. Click the drop-down button
on the Document class field and select the class of document for which you
would like to create a list. When you have selected a document class, the
Document titles field is automatically populated with all available choices.
Highlight one and click Add. Hold
down the Control key to select more than one title at a time. To select a title
from your list as your default, highlight it and click Set as Default. Click Save
Changes if you will be making more changes on this dialog before you click OK.
The
Document Titles dialog
Reports Tab
This tab allows you to set the date ranges and the maximum
number of occurrences for CPRS reports. You can change the settings for all
reports or for individual reports.
The Reports tab
Set All Reports …
This option allows you to set a start date, a stop date, and
a maximum number of occurrences for all CPRS reports.
When this dialog appears follow these steps:
1.
Select Tools |
Options.
2.
Select the Reports tab.
3.
Select the Select All Reports… button.
After you press the Set All Reports… button the “Change
Default Settings For Available CPRS Reports” dialog will appear.
The Change Default Setting For
Available CPRS Reports dialog
4.
Change the value in
the Start Date and Stop Date fields by selecting the appropriate field and by
doing one of the following:
o
entering a date (e.g.
6/21/01 or June 21, 2001).
o
entering a date
formula (e.g. t-200).
o
pressing the button to bring up a calendar.
5.
After you have entered
a start and stop date, you can change the maximum number of occurrences (if
necessary) by selecting the Max field.
6.
Select OK.
A confirmation dialog box will
appear.
7.
Select Yes to confirm
and save your changes.
8.
Select OK to close the
Options dialog box.
Set Individual Report…
This option allows you to set a start date, a stop date, and
a maximum number of occurrences for individual CPRS reports. After you press
the Set Individual Report… button
the “Customize Individual CPRS Report Setting” dialog box will appear.
You
can customize individual CPRS reports from this screen
When this dialog appears follow these steps:
1.
Place the cursor in
the “Type the first few letters of the report you are looking for:” field
(located at the top of the dialog box) and type the name of the report that you
would like to change
-or-
use the scroll
bars to find the report.
2.
Change the value in
the Start Date and/or Stop Date field by clicking in the appropriate column and
doing one of the following:
a.)
entering a
date (e.g. 6/21/01 or June 21, 2001).
b.)
entering a date
formula (e.g. t-200).
c.)
pressing the button to bring up a calendar.
3.
After you have entered
a start and stop date, you can change the maximum number of occurrences (if
necessary) by clicking in the Max field.
4.
Click Apply to save
your changes
-or-
click OK to save your changes and
close the dialog box.
5.
Click OK to close the “Options” dialog box.
Graphs Tab
From the Graphs tab, users can configure collections of data
as Graphing view definitions and configure the default graphing settings. Both
buttons on this tab bring up dialogs that are discussed elsewhere in this
manual.
The Graphs tab
For instructions on
these two dialogs, please see the following sections:
● “Creating Predefined Views”
● “Setting Display Options Using the Graph Settings Dialog
Box”
Surrogates Tab
This tab allows you to add, edit and remove multiple
surrogates for a provider in a single screen.
It displays a list of all current and future surrogates and prevents you
from scheduling more than one surrogate for the same date/time period.
A surrogate is a person who will receive all notifications
that originally would have been sent to the user. It is a way of providing coverage when one
party is unavailable.
The
Surrogates tab
To add a surrogate, follow these steps:
1.
Select Tools |
Options.
2.
Select the Surrogates tab.
3.
To set a default
surrogating period, check the Use
default Start and Stop dates when entering a new surrogate checkbox. Enter a value from 1 to 30 in the Default surrogating period (1..30 days)
text box.
Note: The Use
default Start and Stop dates when entering a new surrogate checkbox is
optional.
4.
Click on the Add Surrogate button or double click
the Dbl-click here to add surrogate
button.
After you press the Add Surrogate button the “Surrogate
Management” dialog will appear. Red highlighting has been added for
emphasis. In the screenshot below, the
default Start Date is the current date
and is listed in the Start
dropdown. The default Stop Date that you
have selected is listed in the Stop
dropdown.
If you have set a default
surrogating period, you can change the Start and Stop dates.
If you have not set a default surrogating period, the Start and Stop dropdowns
in the “Surrogate Management” dialog will be blank.
If you
change the Start and Stop dates, you will not be able to select a past date,
but you can select the present date or any date in the future.
The Surrogate Management dialog
5.
Select a surrogate in
the Name dropdown.
6.
If desired, change the
value in the Start and Stop fields by pressing the calendar button and entering a date and
time.
Listed below is an example of a
calendar. It will show you all the
acceptable start dates and times. The Midnight button sets the time to
midnight and the Now button sets the
time to the current time.
Example of a
Calendar
7.
Click OK.
8.
On the Surrogates
Management screen, click Apply.
9.
Click OK to close the Options screen.
Listed below
is a surrogate that has been added. The
exclamation mark indicates that there is information that has not been
applied. The Cancel button closes the Options window without saving changes.
Example of a Surrogate who has been added
To edit a surrogate, follow these steps:
1.
Select Tools |
Options.
2.
Select the Surrogates tab.
3.
Click on a surrogate.
4.
Click on the Edit Surrogate button and update the
surrogate information. (You will see a Surrogate Management popup that lets you
update the Name and the Start and Stop date/times.)
5.
Click Apply to save your changes.
6.
Click OK to close the Options window.
To remove a surrogate, follow these steps:
1.
Select Tools |
Options.
2.
Select the Surrogates tab.
3.
Click on a surrogate.
4.
Click on the Remove Surrogate button.
You will see
a popup that asks you to confirm that you want to remove the surrogate.
Remove Surrogate
popup
5.
On the Remove
Surrogate popup, click OK.
6.
On the Surrogates
Management screen, click Apply to
save your changes.
7.
Click OK to close the Options window.
Copy/Paste Tab
This tab allows you to determine how pasted Notes will
display in CPRS.
The Copy/Paste Tab
To determine how pasted Notes will display in CPRS, follow
these steps:
1.
Select Tools |
Options.
2.
Select the Copy/Paste tab.
3.
Check the “Copy/Paste
viewing is currently disabled” checkbox.
After the checkbox gets checked, the wording will change to “Copy/Paste
viewing is currently enabled.”
4.
In the “How text is
identified on the note” section, select the attributes for pasted text by
checking one or more of the following boxes:
Bold
Italics
Underline
Highlight
5.
If you select
“Highlight”, you may also use the default color or choose a different color. To
select a different color, select the drop-down arrow and choose one of the
following colors:
Black
Maroon
Green
Olive
Navy
Purple
Teal
Gray
Silver
Red
Lime
Yellow
Blue
Fuchsia
Aqua
White
6.
If you would like to
see the differences between what the author pasted into the note and what was
edited, check the “Difference Identifier Toggle”.
7.
If you check the
“Difference Identifier Toggle”, you may select the following:
i
Select the attributes
for edited text by checking one of more of the following boxes:
Bold
Italics
Underline
Text Color
ii
If you select “Text
Color”, you may use the default color or choose a different color. To select a different color, select the
drop-down arrow and choose one of the following colors:
Black
Maroon
Green
Olive
Navy
Purple
Teal
Gray
Silver
Red
Lime
Yellow
Blue
Fuchsia
Aqua
White
iii
Enter the character
limit. The default number of characters
is 5000.
8.
Click Apply to save your changes.
9.
Click OK to close the Options window.
Listed below is an example of Copy/Paste viewing that is set
to enabled. The pasted text will be
highlighted in lime and the Difference Identifier Toggle has been enabled. The edited text will be in aqua and the
character limit will be 50.
Example of
Copy/Paste text viewing enabled
Support
for Women’s Health
CPRS now offers support for items related to Women’s Health,
including for the System for Mammogram Results Tracking (SMART) and order
checking for items that are teratogenic or potentially unsafe for breastfed
infants.
SMART Features
SMART enhances the ability to track and manage mammography
results. SMART creates the ability to link a result notification directly to a
documentation template. These templates are specific to the Breast Imaging
Reporting and Data System (BIRAD) code and contain typical next steps in
management, links to orders, and ability to document how and when a patient was
notified of their result.
The template allows users to view the patient’s last three
breast images, regardless of the ordering provider; and to view all data
captured in CPRS/VistA related to the patient’s breast care, beginning with
when the result was entered into VistA. Once implemented, data from the SMART
templates will populate the Breast Cancer Clinical Case Registry (BCCCR),
enhancing the registry.
SMART features in CPRS include:
● new alerts
● a new alert dialog that is patient-centric rather than
provider-centric
● new reminder dialogs and TIU templates
The features should allow providers to get the alert for a
mammogram and process the alert. The patient-centric alert dialog should enable
providers to more easily see the alert for the patient if needed. The dialog
displays all alerts for the patient, not just SMART alerts.
Note: Each user must enable their own SMART alerts. If a user does
not enable SMART alerts, they will not receive them. When SMART alerts are not
enabled, the user receives normal imaging alerts based on their configured
settings.
When the provider processes a SMART alert, it will take them
to a template containing a reminder dialog. The provider and fill out the
appropriate BIRAD dialog that helps the provider record the result and follow
up actions.
Completing the template and dialog
● creates a progress note
● files health factors
● when available, updates the BCCCR
Potentially Unsafe Medications or Exposures
(Teratogens)
Teratogens are drugs (including medications), chemicals, or
other exposures, like radiation, that can interfere with normal embryonic/fetal
development and thus, may lead to birth defects or pregnancy loss. In addition,
there is a group of medications that pose a potential risk to breast-fed
infants.
CPRS has enhanced order checks to alert providers if
something is ordered for a woman that is pregnant or breast feeding that is
teratogenic.
Documenting
a Patient’s Immunizations and Skin Tests in CPRS
Before CPRS v32b (OR*3.0*405) was released, most
documentation about a patient’s immunizations and skin tests was listed as free
text information in a progress note.
However, CPRS now provides clinical computable data when a user
documents these items.
When documenting the administration or reading of an
Immunization or a Skin Test in all locations, CPRS will automatically add
specific Current Procedural Terminology (CPT) and International Classification
of Diseases-10 (ICD-10) codes associated with it. CPRS will also add the
correct administration CPT codes.
Note: CPRS will
not allow you to document an immunization unless it is marked as Active in the
Immunization file and has available Lot Numbers for the encounter location.
CPRS does not allow you to enter a future date/time for an immunization or skin
test.
You can document a patient’s immunization from these
locations in CPRS:
● Coversheet
● Immunization tab in the Encounter form
● Reminder Dialogs.
You can document a patient’s skin tests from these locations
in CPRS:
● Skin Test tab in the Encounter form
● Reminder Dialogs.
Description of the Enter Immunization/Skin Test
Screens
Regardless of the location from where you start recording
the immunization/skin test, CPRS will always take you to the Enter Immunization
or Enter Skin Test screen, which has the following sections:
● Immunization/Skin
Test Evaluation Statuses: Lists the
immunizations or skin tests.
● Immunization/Skin
Test List: Shows the immunizations or skin
tests that are in the patient record. If
you have accessed the Enter Immunization screen from the coversheet, the
Immunization List will be filled in only when a user is currently entering an
immunization. If you have accessed the Enter Immunization screen from the
Immunization tab in the Encounter form, the Immunization List will always
contain a patient’s immunizations.
● Immunization/Skin
Test Selection: Allows you to select an
immunization/skin test and a documentation type.
● Editor/Detail
Viewer: Displays the fields associated
with a specific document/skin test type and allows you to edit them.
After you access the Enter Immunization/Skin Test screen,
you will be able to add, edit, delete, or view an immunization/skin test.
The examples below show what the Enter Immunization screen
looks like when you open it from the Coversheet, and what the Enter Skin Test
screen looks like when you open it from the Encounter form.
Example of the
Enter Immunization screen
Example of the
Enter Skin Test screen
Accessing the Enter Immunization Screen from the Coversheet
When documenting an immunization from the cover sheet, a
progress note will automatically be generated, with a standard text for the
Immunization entry.
- Right-click on the Recent Immunizations pane and select Enter New
Immunizations on the dropdown.
- If an encounter location hasn’t been selected, the
Location for Current Activities screen will appear, and you will need to
select an Encounter Location and Date/Time of Encounter.
- You will now see the Enter Immunization
Screen.
Accessing the Enter Immunization/Skin Test Screen from the Encounter form
- On the Encounter Form screen, click the Immunizations or Skin Test
tab.
- On the Immunizations/Skin Test tab, click the Add/Edit/Delete
Record button.
- You will now see the Enter
Immunization/Skin Test screen.
Accessing the Enter Immunization/Skin Test Screen from the Reminder Dialogs
- Click on the button in the Reminder Dialog
that takes you to the immunization/skin test form.
Adding an Immunization/Skin Test to CPRS
- On the Enter Immunization/Skin Test screen:
- If you are adding an immunization:
i. On the Enter Immunization screen, select a Documentation
Type and an Immunization in the Immunization Selection section.
- If you are adding a skin test:
i. On the Enter Skin Test screen, select a Documentation Type
and a Skin Test in the Skin Test Selection Section.
- Fill in all required fields (marked with an asterisk) for the
selected Documentation Type.
- Click Save.
- Click Finish.
Administered and historical vaccines will be listed on the CPRS
Coversheet. Contraindicated and
refused vaccines will not be listed on the Coversheet. However, they will be listed on the
Encounter Form 🡪 Immunizations tab.
If a vaccine was contraindicated, you will get a warning message
when you click Finish.
Note: If
a user sets the Contraindication/Precaution Reason or Refused Reason to a
health condition that has a default reschedule date, the “Cancel Series and
stop forecasting” dropdown will default to “No” and will be disabled, as shown
below.
Example of a contraindicated immunization with a default reschedule date
When a user sets “Cancel Series and stop forecasting” to
Yes, the following message will appear on the dropdown: “Yes, this will stop
the forecasting reminders of future doses.’
Editing an Immunization/Skin Test in CPRS
- On the Enter Immunization/Skin Test screen, right-click on an
immunization/skin test in the Immunization/Skin Test List section and
select Edit Immunization/Skin Test from the dropdown.
- In the Editor/Detailed Viewer section, update the information about
the immunization/skin test.
- Click Save.
- Click Finish.
Note: You can always edit an immunization/skin
test if you accessed the Enter Immunization/Skin Test screen through the
Immunization/Skin Test tab in the Encounter form. However, if you accessed an immunization
through the Coversheet, you can edit it only under this condition: You have added an immunization and saved
it, but you have not finished it and have kept the Edit Immunization
screen open.
Deleting an Immunization/Skin Test in CPRS
- On the Enter Immunization/Skin Test screen, right-click on an
immunization/skin test in the Immunization/Skin Test Lists section and
select Delete Immunization/Skin Test from the dropdown.
- Click Save.
- Click Finish.
Note: You can always delete an
immunization/skin test if you accessed the Enter Immunization/Skin Test
screen through the Immunization/Skin Test tab in the Encounter form. However, if you accessed an immunization
through the Coversheet, you can delete it only under this condition: You have added an immunization and saved
it, but you have not finished it and have kept the Edit Immunization screen
open.
Viewing the Immunization/Skin Test Status in CPRS
- On the Enter Immunization/Skin Test screen, right-click on an
immunization/skin test in the Immunization/Skin Test Evaluation Statuses
section and select either View Information or Clinical Maintenance from
the dropdown.
Note: View Information and
Clinical Maintenance display the same information about the patient’s
immunization history. However, View
Information displays the information on the right-hand side of the
Immunization Evaluation Statuses section while Clinical Maintenance
displays the information on a separate screen and allows you to print it.
- Click Finish.
The Cover Sheet is the first screen you
see after opening a patient record (unless the site or user defines another tab
as the initial screen). The Cover Sheet displays an overview of a patient’s
condition and history. It shows active problems, allergies and postings, active
medications, clinical reminders, lab results, vitals, and a list of
appointments or visits.
The CPRS Cover
Sheet displays a variety of information about a patient. This example shows the
Cover Sheet without customization. Sites can now customize which panels display
and their order as described below.
Customizing which Panes Display and
their Order
Sites can now customize
the CPRS Cover Sheet determining which panes display. There are ten possible
panes. The CAC or similar personnel can set the pane order. There will still be
three rows available for the panes, which are
●
Active Problems
● Allergies
● Postings
● Active Medications
● Clinical Reminders
● Recent Lab Results
● Vitals
● Appointments
● Immunizations
● Women's Health
Customizing
which panels display must be done by someone who has access to the Clinical
Application Coordinator (CAC) menu.
With the customized Cover
Sheet, the panels have a slightly different appearance and the user can
minimize and maximize the panels on the Cover Sheet to see things better.
This capture shows a Cover Sheet that has been customized and
three of the panels have been collapsed. Each of the collapsed panels have a
small box with a plus sign that can be used to expand it. In the expanded
panels, there is also a refresh icon. Right-clicking on these refresh icons
will show some options, such as Refresh, Expand or Collapse, and possibly other
options, such as No Known Allergies on the Allergies panel.
Minimizing and Maximize Panels
When the Cover Sheet is
customized, each panel can be minimized or maximized. When the panel is
maximized, the user can select the minus icon in the panel’s upper left corner
to minimize the panel. When minimized, the panel is a smaller vertical area
with the name of the panel listed vertically as shown above. If the panel is
minimized, the user can select the plus icon to maximize the panel.
Refresh Icon Options
Each customized Cover Sheet
panel also has a refresh icon (
)in the upper right corner of the
panel. If the user right-clicks the refresh icon, there are options to Refresh
and Collapse, and there may be other menu items, such as Update Vitals, Enter
New Allergy, Mark as Entered in Error. Each panel has the Refresh and Collapse.
Some panels have additional items. Right-click the Refresh icon for each panel
to see which options are available.
What You Can Do from the Cover Sheet
You can quickly review the active problems (asterisks
identify acute problems, and dollar signs identify unverified problems.
Service-Connected conditions are indicated by abbreviations in parentheses if
Problem List patch GMPL*2.0*26 is installed. The pound symbol “#” shows
problems that have inactive codes, which users can update using the Change
action on the problems tab).
Scroll bars beside a box mean that more information is
available if you scroll up or down.
The File menu contains three menu items that you will use
often:
•
Select New
Patient
This menu item
opens the Patient Selection dialog.
•
Update/Provider/Location
This menu item opens the Provider
& Location for Current Activities dialog. This dialog enables you to change
the clinician or location associated with an encounter.
•
Review/Sign
Changes
This menu item enables you to view
the orders you have placed that require an electronic signature, select the
orders you want to sign at this time, and enter your electronic signature code
(if you are an authorized signer).
Click any item to get more detailed information. For
example, you can click the Patient
Identification box (or button) to get more information about the patient.
You can click a Visit to see
details. For example, a patient could have Zantac listed in the
Allergies/Adverse Reactions dialog. By clicking on it, you would see the
following detail window.
Note: If the
provider has an NPI, it will not display on the screen below.
The
Detail window displays additional information about an allergy
Select a tab at the bottom of the screen to go to that
section of the patient chart.
The
CPRS tabs allow you to easily navigate to another area of the patient chart
Navigating a Patient Chart
The CPRS Windows interface mimics the paper chart of a
patient’s record, but CPRS makes locating information easier. With the Patient
Selection screen, you can quickly bring up a record for any patient on the
system. The Cover Sheet summarizes important information about the patient.
Along the bottom of this dialog or page are a number of tabs that will quickly
take you to the part of the chart you need to see. For example, you might want
to see progress motes, Problems, Summaries, Medications, Lab Tests, or place
new orders:
To go to a different part of the patient chart, click the
appropriate tab at the bottom of the chart or choose View | Chart Tab, and then select the desired tab.
Additional Patient Information
You can obtain additional patient information by clicking
the Patient ID box located on the
upper left of the dialog. You can access this button from any chart tab.
The button shows the patient’s name (in bold), status
(inpatient or outpatient), Social Security number, date of birth, and age (as
shown in the graphic below). If you click the button, CPRS brings up a window
containing additional information such as the patient’s address, the attending
physician, and/or the date of admittance.
Information
about a patient is displayed in the Patient ID box
To obtain additional information about a patient, follow
these steps:
1.
Select the Patient ID box.
The Patient Inquiry dialog will
appear. The Patient Inquiry dialog includes additional information such as the
patient’s mailing address, telephone numbers (including the patient’s home,
work, and cell phone numbers), admission information, and other relevant data,
such as provider information and primary and secondary next of kin entries. If
the patient is assigned to a mental health treatment coordinator (MHTC), the
provider’s name, position and phone numbers will display as well. While in the
detailed display, you can select a new patient, print the detailed display, or
close the detailed display.
2.
To print a copy of the
Patient Inquiry dialog, select Print.
3.
To close the Patient
Inquiry window and return to the Cover Sheet, select Close.
-or-
select a new patient by selecting Select New Patient.
Note:
If the provider has an NPI, it will not display on the screen above.
You
can retrieve additional information about a patient by clicking the Patient ID
button. The Patient Inquiry dialog also shows information that can be printed
including demographic information, Permanent & Total Disabled status, and
Health Benefit Plans currently assigned to the Veteran
Entering or Changing Encounter Information
You must enter encounter information before you can enter
orders, write progress notes, complete a consult, write a discharge summary, or
perform other activities.
Note: If the
provider has an NPI, it will display on the screen below. See the "National Provider Identifier
(NPI) Display in CPRS" section for an example of an NPI displaying on a
screen.
You
must complete the Provider & Location for Current Activities dialog before
you can perform certain activities
To enter or change the Encounter provider, follow the steps
below:
- If you are already in the Provider /
Encounter dialog skip to step 2. Otherwise, from any chart tab, click the
Provider / Encounter box located in the top center portion of the dialog.
Note: These instructions are written as if the user must select a
provider. If the user making the selection is a provider, the user will be
selected by default and the cursor will go to the New Visit tab if no visit is
defined, or to the Clinic Appointments tab if one is defined. If the user is
not a provider, the cursor will go to the Encounter Provider field so that the
user can select the provider for the encounter.
- Locate and click the provider for this encounter in the list box.
- Select the tab of the correct encounter category for this visit:
●
Clinic Appointments
●
Hospital Admissions
●
New Visit
- Select a location for the visit from the choices in the list box.
- If you selected a Clinic Appointment or Hospital
Admission, skip to step 7. If you are creating a New Visit, enter the date
and time of the visit (the default is NOW).
- Select a visit category from the available options (such as,
Historical) and click OK.
- When you have the correct provider and
location, select OK. If the Similar Providers screen appears, select a
provider from the list and select OK.
Note: If the last name and the
first two letters of the first name match another provider, CPRS will
display the Similar Providers screen, which will prompt the user to
select the right provider from a list of providers with similar
names, as shown in the screenshot below. This functionality exists in
thirty-seven areas of CPRS but it always works the same way.
Similar Providers screen
Viewing Clinical Reminders
From the Cover Sheet, you can double-click any of the
Clinical Reminders listed to obtain a description of the reminder and an
explanation of why the reminder applies to the current patient. To process
reminders, you must go to the Notes tab.
You
can view a description of a reminder from the Cover Sheet
If there is a problem when the reminders are evaluated, CPRS
uses two messages to inform the users: Error and CNBD, which stand for “could
not be determined.”
Here the Clinical Reminders portion of the Cover Sheet
display of an error in reminder processing.
This screen capture shows CNBD for “could not be determined”
in the Due Date column.
Both of these messages indicate that someone needs to review
the Reminder definition to address the problem. If the user double-clicks the
reminder with the error message, a dialog will appear either telling them to
contact their reminders coordinator or the message might show why the reminder
did not get processed similar to the capture below.
Here
the reason for the CNBD is shown. This reminder is missing a frequency.
Viewing and Entering Vitals
CPRS uses the new Vitals
Lite component to view and enter the following vitals and measurements:
● Blood pressure
● Central venous pressure
● Circumference/girth
● Height
● Pain
● Pulse
● Pulse oximetry
● Respiration
● Temperature
● Weight
Users bring up detailed vitals information by clicking
anywhere in the vitals area on the CPRS cover sheet. By using the new Vitals
Lite component, CPRS users can enter vitals with qualifiers, such as sitting,
standing, actual, estimated, left arm, right leg, etc., and then on the Cover
Sheet, CPRS displays the all vitals that have a value entered, any qualifiers,
and the date the vital was entered. For example, a user might see blood
pressure, temperature, and pulse from two months ago, while a value for pulse
oximetry might be from six months ago.
CPRS users can enter vitals with qualifiers from the Cover
Sheet or from the Vitals tab of the Encounter form.
The following items are also displayed in the Vitals view:
•
Body Mass Index (BMI):
This value is calculated using the following formula:
BMI = Weight in Kilograms/[(Height in Meters) x
(Height in Meters)]
•
L/Min/%: Liters per
minute of oxygen or percentage is entered when the user enters oxygen
saturation based on Pulse oximetry.
•
In 24hr (c.c.): Intake
for the past 24 hours measured in cubic centimeters is taken from the Intake
and Output package.
•
Out 24hr (c.c.):
Output for the past 24 hours measured in cubic centimeters is taken from the
Intake and Output package.
How CPRS Displays Vitals
Users can view vitals in CPRS by launching Vitals Lite from
the Cover Sheet. Users can then review vitals using the graph and table of
vitals.
The values for vitals display as points on the graph
connected by line to show trends. A legend above the graph lets the user know
what each set of points, distinguished by a shape and color, represents.
The
Vitals Lite View dialog displays vitals and measurements in a grid or a graph
Note: If the
provider has an NPI, it will not display on the screen above.
Below the graph is a table or grid containing columns of
vitals entries. Each column represents the vitals entered at a specific date
and time. Each column has 14 rows that contain the vitals measurements whether
observed or calculated. Each column also lists the location where the vitals
were entered and the name of the person who entered them. The most recent
entries are the furthest to the right.
Users enter some values while others are drawn from existing
data or calculated. For example, the intake and output for the last 24 hours is
only displayed if that information is available from the corresponding package,
but the body mass index is calculated based on height and weight.
Note: If the user has not entered a height when a
weight is entered, Vitals Lite will use the most recent height to calculate the
body mass index.
If vitals values have associated qualifiers, qualifier
abbreviations display after the value in the table. For example, 120/80 LA Si
Cu Ad stands for a blood pressure of 120/80 taken on the left arm while the
patient was sitting using a cuff of adult size.
If a value is displayed in red with an asterisk, it means
that the value is outside of an acceptable range that can be set locally. A GMV
MANAGER key holder can set acceptable ranges for vitals through the
VitalsManager application.
How the Vitals View Can Be Changed
To get the view they want, users can customize the Vitals
Lite display using the following controls:
•
Date range: By
default, Vitals Lite displays six months of vitals beginning with today for
outpatients or 7 days beginning with today for inpatients. Users can set the
date range by double-clicking a predefined choice (Today, T-1, T-2, T-3, T4,
T-5, T-6, T-7, T-15, T-30, Six Months, One Year, Two Years, All Results, and
the default date range) or by using the Date Range option to enter specific
dates.
•
Graph options: These
options may not be visible when the graph first displays. If not, the user can
select File | Show/Hide Graph Options or right-click where the predefined time
ranges are and choose Show Graph options. The user can select the checkbox in
front of each of these choices to toggle the item on or off.
o
Values: This selection
displays the numerical value of each point on the graph.
o
3-D: This selection
changes the display between two-dimensional and three-dimensional.
o
Time-scale: This
selection toggles between whether each vitals entry is spaced equally on the
graph regardless of date or whether the graph displays the amount of time the
user designates. For example, if the user selects two weeks, the entire graph
would represent two weeks. So if the user selected a vitals entry on January 1,
2005, the graph would show January 1, 2005 to January 15, 2005. The user can
set the graph to show: 1 hour, 12 hours, Day, Week, Two Weeks, Month, Six
Months, Year, Two Years.
o
Allow Zoom: The
selection enables the user to click-and-drag with the mouse to zoom in on part
of the graph.
•
Categories to display:
The graph shows only those vitals that are highlighted on the left of the grid.
By clicking on a vital in the grid or using the drop-down box between the date
ranges and the vitals in the grid, users select the vitals category to display:
o
TPR: temperature,
pulse, respiration
o
B/P: blood pressure
o
Height/Weight: Height,
Weight, Body Mass Index (BMI, which is calculated by dividing the weight but
the height squared, e.g., )
o
Pain
o
Pulse Ox.: Blood
oxygen saturation based on pulse oximetry
•
Time scale slider: The
slider control is directly under the graph and above the table. Based on the
date range, the slider position determines what portion of the vitals entries
the user will see. Moving the slider furthest to the left shows the oldest
vitals entries within the specified date range. As the slider is moved to the
right, those vitals entries closest to the present display and some of the
older entries will drop off the graph to the right as will entries in the
table. If the user has clicked Time Scale, the points the represent the vitals
entries are equally spaced. If the Time Scale option has been selected, a box
outline shows what portion of the graph the columns showing on the screen
relate to.
•
Select Graph Color…:
This option on the pop-up menu enables users to change the background color of
the graph and the table. To change the color, bring up the pop-up menu by
right-clicking on the dialog (although not on the graph) or pressing the pop-up
menu key, select 'Select Graph' color…, choose the color, and click OK.
Viewing Vitals from the Cover Sheet
As the user moves the slider, the entries move also. If
there are enough entries and the user moves the slider far enough to the left,
the entries will go off the screen. If the user moves the slider all the way to
the right, only the most recent entry will be displayed.
To view vitals from
the CPRS Cover Sheet, use the following steps:
- Select a vital entry displayed on the Cover Sheet.
- CPRS will bring up Vitals Lite. The default date range includes
today and goes six months in the past.
- To graph a category, click on the corresponding row in the
table.
- From this point, you can customize the
display of vitals by doing one or more of the following:
a.
To choose a different date
range, users can double-click a time frame from the predefined options on the
left side or double click Date Range to define a custom date range. If you
choose a predefined date range, skip to step b. If you choose Date Range, enter
a start date by either typing a date in the field (you must enter the month,
day, and year separately using the mouse or arrow keys to select them) or use
the following steps:
1.
Click the down arrow
next to Start with Date to display the date dialog.
2.
Click the buttons on
the top of the dialog to find the appropriate month and year. (You can also
click on the month and select the month from a list and then click on the year
and choose the year).
3.
Repeat steps 1 and 2
for the Go to Date.
4.
Click OK when you have
the appropriate date.
b.
To use the graph options,
right-click where the default date ranges are and select Show/Hide Graph
Options. You can then enable or disable, the zoom feature, display of the
values, three-dimensional display, and the time scale. These options are
discussed below:
o
Values: To display the
values, place a check in the Values checkbox by clicking it or using Alt + v.
To remove the values, remove the check mark.
o
Allow Zoom
1.
To enable the zoom feature,
place a check mark in the Enable Zoom checkbox by clicking it or using Alt + z.
2.
Then, to zoom in on section
of the graph, click and drag the mouse from right to left and above to below
over the area and release the mouse button.
3.
To return to the full view,
click and drag from right to left.
● 3D: To make the graph display in a slightly three-dimensional
(3D) view, place a check mark in the 3D checkbox by clicking it or using Alt +
3. To return to a two-dimensional view, remove the check mark.
● Time Scale: To view the entire selected date range on the graph,
check the Time Scale checkbox. Clear the checkbox to view the data points in
evenly spaced intervals.
c.
To view more vitals if
available in the date range you selected, use the slider under the graph and
above the table or use the arrows keys. The oldest entries are farthest right
while the most recent entries are the farthest to the left.
e.
When you are finished,
click the Close button (the X in the upper right corner).
Recording Vitals
Users can enter vitals and measurements from the Cover Sheet
or the Encounter form’s Vitals tab. A template must be available for users to
enter vitals.
Templates for Entering Vitals
To enter vitals with the new Vitals Lite in CPRS, a template
that defines which vital measurements display on the Vitals Entry form must be
available. These templates are not created through CPRS, but through the
VitalsManager application. To use the VitalsManager application, a user must
hold the GMV MANAGER key.
A GMV MANAGER key holder can define in the template which
vitals or measurements display for entry when the user selects Enter Vitals. In
defining the template, the key holder can also set default qualifiers for each
vital or measurement. The user entering the vitals can change the qualifiers,
but a default can be set to make recording the vitals more efficient. Templates
can be defined at the following levels:
•
System
•
Division
•
Location
•
User
For User level templates to display, a GMV MANAGER key
holder must check the Allow User Templates checkbox.
The dialog to enter vitals displays the following patient
information:
•
Patient name
•
Social security number
•
Birth date
•
Age
•
Encounter location
•
Encounter date/time
•
Vitals and
measurements that can be entered using the specified template
This
screen capture shows the dialog for entering vitals. In this capture, the user
is seeing the Expanded view where they can select a template to use and the
Latest Vitals that allows them to see the most recent vitals entered for the
selected patient
Note: If the provider has an NPI, it will not
display on the screen above.
Templates show the following for each type of vitals that
can be entered:
•
Unavailable checkbox
that records if the vitals cannot be taken. The text for this checkbox may be
very small with only the U displaying.
•
Refused checkbox that
records if the patient refused to have the vital taken. The text for this
checkbox may be very small with only the R displaying.
•
Name shows vital or
measurement name.
•
Value field is where
the user enters the numeric value.
•
Units show what unit
of measurement, such as inches or centimeters, is being used. A checkbox on the
top right of the dialog enables users to switch between drop-down lists and
checkboxes to change the units.
•
Qualifiers show a
drop-down arrow that will bring up a small window with the defined qualifiers
for that vital or measurement. If a default qualifier has been defined, it will
display to the right of the button. If the user changes the qualifiers, the
text to the right of the button changes.
The dialog also has a checkbox to designate that the patient
was on pass and vitals could not be taken.
For more information on how to create and save templates and
the other options that for Vitals Lite, please see the Vitals/Measurements
documentation by going to http://www.va.gov/vdl
and selecting Vitals/Measurements.
Entering Vitals
Once a template has been defined, user can enter vitals and
measurements. Users can choose to display or hide the template list and the
most recent vitals recorded.
To enter a patient’s vitals, use the following steps:
- From the Cover Sheet, select a vitals entry and then select Enter
Vitals using the button or the pop-up menu. On the Encounter form, select
the Vitals tab and select Enter Vitals.
- If prompted, enter a location and then select OK.
- Bring up the Vitals Lite Enter dialog by selecting the Enter Vitals
button or bringing up the pop-up menu and selecting Enter Vitals.
- If necessary, select the appropriate template by doing the
following:
a.
If it is not
displayed, show the Templates pane by selecting Exp. View in the upper right of the dialog.
b.
Select the level at
which the template resides: System, Division, Location, User (user will only
display if it has been set to display).
c.
Select the appropriate
template.
- To view the most recent vitals if they are not displayed, select
the Latest V. (for Vitals) button. Select it again to hide them.
- If you cannot take the vitals, place check marks in the appropriate
boxes. These boxes might be:
o
Patient on Pass – use
this if the patient is on pass.
o
Unavailable – there is
a check box by each vital sign or measurement.
o
Refused – there is a
checkbox by each vital sign or measurement.
- If necessary, change the units for the vital.
- Enter a vitals value for the patient by placing the cursor in the
appropriate field and typing a value.
- Repeat steps 4 and 5 as needed. When
finished, check over the entries and select either Save or Save and Exit.
Marking Vitals as Entered in Error
Through Vitals Lite, users can now mark a vitals entry as
entered in error. The user selects one or more vitals entries from a specific
date and then must select a reason before marking them as entered in error.
To mark vitals entries as entered in error, use the
following steps:
- To bring up the vitals screen from the Cover Sheet, select a vitals
entry using the mouse or appropriate keystrokes.
- Display the dialog by selecting Entered in
Error using the button or the popup menu.
Through the vitals Entered in Error
dialog, users can select the erroneous entries and mark them as entered in
error
- Enter the date of the erroneous entry.
- In the list that displays, highlight the vitals entries that are
incorrect. To select multiple entries, hold down the Ctrl key and click
each entry to select it, or hold down the Shift key and while clicking the
last entry to select a range.
- Select a Reason.
- Select Mark as Entered in Error.
Note: If the provider has an NPI, it will not display on the screen
above.
1.
Assessing, Entering, and Reviewing Allergies/Adverse
Reactions
In the Allergies/Adverse
Reactions pane on the Cover Sheet
tab, CPRS displays a list of causative agents associated with patients’
allergies or adverse reactions. If patients have causative agents listed in
this pane, CPRS also displays the word Allergies
in the Postings pane and the letter A (for allergies) on the Postings button. To view more
information about allergies or adverse reactions associated with the causative
agents listed in the Allergies/Adverse
Reactions pane, simply click on the causative agent in which you are
interested. CPRS then displays a comprehensive listing of the details
associated with this causative agent.
You can obtain less comprehensive information about
allergies and adverse reactions by clicking the word Allergies in the Postings
pane. When you do this, CPRS displays information about the causative agents,
severity, and signs/symptoms associated with patients’ allergies and adverse
reactions. From the Cover Sheet tab, you can also:
•
Enter new allergies
•
Mark existing
allergies or adverse reactions as having been entered in error
•
Enter
no-known-allergies (NKA) assessments
Entering
Allergies
You can enter a new allergy or adverse reaction from the Cover Sheet tab in either of two ways:
•
Right-click anywhere
within the Allergies/Adverse Reactions pane.
•
Click to display more
information about a causative agent listed in the Allergies/Adverse Reactions pane.
Method One
Take the following steps to enter new allergies using the
first of the two methods mentioned above:
- Move your mouse arrow to a location anywhere within the
Allergies/Adverse Reactions pane.
- Right click to display a pop-up menu.
- From this menu, select Enter new allergy. CPRS displays the Allergy
Reactant Lookup dialog.
- In the Enter causative agent for Allergy or Adverse Drug Reaction
field, type the first three characters (minimum) of the causative agent’s
name.
- Click Search. CPRS displays a list of possible matches.
- If you click on any drug
ingredient listed in the Drug Ingredients File dropdown, you will get a
notification that Drug Class cross checking will not occur. However, if you check the checkbox next
to the notification, you will be able to enter the drug ingredient, as
shown below (the notification is highlighted in red for emphasis):
![Screenshot of a user selecting the CAPTOPRIL drug listed in the Drug Ingredients File dropdown and getting this message: If this is a reaction only to the ingredient selected [CAPTOPRIL], check the box to continue. IIf it may be a reaction to other drugs in the same class, please select an item higher on the list.](user.fld/image255.jpg)
- If the causative agent
you typed does not match any of the agents currently available for your
site, CPRS displays the Causative Agent Not On File dialog, from which you
can select one of the following three options:
Note: The patient’s chart
will not be updated unless you choose a causative agent that is on file.
a. Yes:
Use this option to request that the causative agent be added to your site’s
ALLERGIES file. When you click Yes,
CPRS displays the Enter Optional
Comments dialog, which enables you to type additional comments (optional),
such as the signs or symptoms that occurred as a result of contact with this
causative agent, or whether you observed these symptoms firsthand. After you
type your comments, click Continue. CPRS then sends to members of your site’s GMRA Request New Reactant mail
group a message that includes the following items:
● The causative agent you attempted to enter
● The name of the patient for whom you attempted to make this
entry
● Your name, title, and contact information
● Your comments (if any)
Note: When the
bulletin is sent, a message such as the following will display. This message
also informs the user that the allergy was NOT entered into the patient’s
record.
This message box informs the user
that the bulletin has been sent, but no information has been added to the chart
Members of your site’s GMRA
Request New Reactant mail group will review this message and, if appropriate,
add the causative agent to your site’s ALLERGIES file.
Note: If your site’s IRM staff has not yet added members to your
site’s GMRA Request New Reactant mail group, CPRS displays the following
message:
CPRS displays this message if your
IRM staff has not yet added members to the GMRA Request New Reactant mail group
b.
No: Clicking No enables you to try an alternate
spelling or trade name for your causative agent, or to type another causative
agent.
c.
Cancel: Use this
option if you want to cancel your allergy entry.
The Causative Agent Not On File
dialog
- If the causative agent
you typed matches an agent that is currently available for your site,
select the agent. (Click + to expand a heading.)
Note: With CPRS GUI 24 or later, you
may not add free-text causative agents. If you select an item under the “Add
new free-text allergy” heading, CPRS displays the Causative Agent Not On File dialog. (See Step 6 above.)
- Select OK.
The Enter Allergy or Adverse
Reaction dialog appears.
The Enter Allergy or Adverse
Reaction dialog
Note: You can view a patient’s current allergies or adverse reactions by
selecting the Active Allergies
button. Also, the user previously could change the Originator, but this is no
longer allowed. The originator is the user logged in.
Note: If a provider has an NPI, it will display on the screen
above. See the "National Provider Identifier (NPI) Display in CPRS"
section for an example of an NPI displaying on a screen.
- Use the Observed or Historical radio button
to indicate whether the entry is for an observed or historical allergy,
respectively. (If you point your mouse at either of these option buttons,
CPRS displays a hover hint that defines observed and historical.)
Note: Observed or
Historical used to have a default, but the user must now select the appropriate
choice. CPRS does not allow you to select future dates for observed
allergy/adverse reaction entries.
Note: When you select
Observed for a drug reaction, CPRS generates a Progress Note. Once this note is
signed by the user entering the allergy or by an administrative update user,
the note will be viewable by all users.
- Select the Nature of Reaction (Allergy,
Pharmacological, or Unknown).
The Nature
of Reaction can be Allergy, Pharmacologic, or Unknown. An allergic reaction
occurs because the patient is sensitive to a causative agent, regardless of the
amount the patient is exposed to. A pharmacologic (nonallergic) reaction occurs
when the patient is sensitive to an agent under certain conditions, such as
exposure to a large amount. Unknown is provided if you are not sure what Nature
of Reaction (mechanism) to enter.
Note: Allergies are a subset of adverse reactions.
All allergies are adverse reactions, but not all adverse reactions are
allergies.
- If you are entering an observed allergy,
use the Reaction Date/Time and Severity boxes to select a reaction date,
time, and severity. (The Severity box is not visible for historical
allergies. If the Severity box is visible, CPRS displays a ? button at its
side. If you click this button, CPRS displays text explaining severity
selections.)
In the Enter Allergy or Adverse
Reaction dialog, the Severity field shows what levels of severity the user can
select
- Using the Signs/Symptoms box, select one or
more signs or symptoms. The signs and symptoms you select appear in the
Selected Symptoms pane.
Note: You must enter at least one
Sign/Symptom or enter a comment of at least four characters when documenting a
historical allergy/adverse drug reason.
Signs and symptoms must be selected from the Signs/Symptoms list. Users
cannot enter free-text entries.
- To associate a date and time with a symptom
(optional), click to select the symptom in the Selected Symptoms pane.
- Click the Date/Time button located below
the Selected Symptoms pane. CPRS displays the Select Date/Time dialog,
from which you can select the date and time that the symptom first
appeared.
Note: If you mistakenly
enter a sign or symptom but have not yet accepted it by selecting OK, select
the symptom in the Selected Symptoms
pane and click the Remove button
located beneath the pane.
- Type comments for the allergy in the Comments box.
- If you have marked the allergy or adverse
reaction on the patient’s identification (ID) band (or if you know that
someone else has), select the ID Band Marked check box.
Note: CPRS activates the ID
Band Marked check box only for inpatients and then only if your site’s IRM
staff has set a parameter indicating that your site wants to track this
information. Depending on whether your
IRM staff has set related parameters, if you do not select activated ID Band
Marked check box, the system may send a bulletin notifying a mail group
that the patient’s allergy or adverse reaction is not marked on his or her ID
band.
- Select OK.
Note: When you click OK,
CPRS generates an email bulletin to the GMRA MARK CHART mail group. The
bulletin provides a reminder that the patient chart must be updated with the
allergy/adverse reaction information displayed in the bulletin message.
- If the newly entered
allergy is related to existing pending and active orders, then the
Existing Medication Allergy dialog is displayed for each order discovered,
as shown below:
- An Existing Medication Allergy will result in the NEW ALLERGY
ENTERED/ACTIVE MED notification being sent to the default providers
defined in the ORB PROVIDER RECIPIENTS parameter. Those providers who are able to receive
the notification are displayed.
Note, if a default provider recipient is unable to receive the
notification they will not be listed.
- The person entering the new allergy will
also be able to select Optional Recipients to receive the NEW ALLERGY
ENTERED/ACTIVE MED notification.
CPRS
displays the newly entered causative agent in the Allergies/Adverse Reactions pane. If you highlight the causative
agent, CPRS displays all of the information you just entered about the
associated allergy or adverse reaction. CPRS also displays the letter A (for allergies) on the Postings button and the word Allergies in the Postings pane. If you select the word Allergies in the Postings
pane, CPRS displays selected information about all of the patient’s active
allergies and adverse reactions, including the allergy or adverse reaction you
just entered.
Method Two
Take the following steps to enter a new allergy using the
second of the two methods mentioned above:
- Select a causative agent listed in the
Allergies/Adverse Reactions pane. CPRS displays a dialog that includes
details about the allergy or adverse reaction associated with the selected
causative agent. The dialog also includes four buttons.
Note: If the
provider has an NPI, it will not display on the screen below.
The
causative agent dialog contains details about the allergy or adverse reaction
associated with the selected causative agent. In addition, it includes four
buttons
- Select the Add New button.
CPRS displays the Allergy
Reactant Lookup dialog.
- Follow steps 4 through 18 of the
instructions for entering allergies using the first method. CPRS displays
the newly entered causative agent in the Allergies/Adverse Reactions pane.
If you click on the causative agent, CPRS displays all of the information
you just entered about the associated allergy or adverse reaction. CPRS
also displays the letter A (for
allergies) on the Postings button and the word Allergies in the Postings
pane. If you click the word Allergies in the Postings pane, CPRS displays
selected information about all of the patient’s allergies or adverse
reactions, including the allergy or adverse reaction you just entered.
Method Three
A user can do an allergy assessment when discontinuing a
medication order:
- Click on either the Meds or Orders tab.
- Right-click on a medication order and then, select
Discontinue Order on the dropdown. If a visit location hasn’t been
selected, the Location for Current Activities screen will appear, and you
will need to select a Visit Location and Date/Time of Visit.
- On the Discontinue Order screen, select
Allergy/Adverse Drug Reaction on the Reason for Discontinue list, and
then, click OK.
Example of the Discontinue Order
screen
- On the List of allergies currently recorded
for the patient screen, click on the Yes button.
Example of the List of allergies currently recorded for the patient screen
- Do an allergy assessment by following steps
4 through 21 in Method One.
Entering
No-Known-Allergies Assessments from the Cover Sheet
You can enter no-known-allergies (NKA) assessments for
patients who have no active allergies by taking the following steps:
- Right-click within the Allergies/Adverse
Reactions pane.
- From this menu, select Mark patient as
having No Known Allergies (NKA).
CPRS displays the No Known Allergies dialog.
The
No Known Allergies dialog
Note: CPRS
activates The Mark patient as having No
Known Allergies (NKA) menu selection only for patients who have no active
allergies.
When patients have active allergies, CPRS deactivates this
selection.
- Select OK.
Marking Allergies as
Entered in Error
CPRS offers two methods for marking allergies as having been
entered in error. To mark an allergy as entered in error, the user must have
the parameter OR ALLERGY ENTERED IN ERROR appropriately set.
Method One
Take the following steps to use the first method:
- In the Allergies/Adverse Reactions pane, place your mouse pointer
over an erroneously entered causative agent and right-click to display a
menu.
- From this menu, select Mark selected
allergy as entered in error.
CPRS
displays the Mark Allergy/Adverse Reaction Entered In Error dialog.
The
Mark Allergy/Adverse Reaction Entered in Error dialog
- If your site has enabled the Comments
feature, you may (optionally) type comments in the Comments (optional)
text box.
Note: If your site has not enabled the Comments feature, CPRS disables the dialog, which in this case is
named Comments (disabled).
- Select OK. CPRS displays an Are you Sure? dialog.
- If you are sure the causative agent was
entered in error, click Yes. CPRS removes the causative agent from the
Allergies/Adverse Reactions pane and from the list of allergies it
displays when you click Allergies in the Postings pane.
Note: CPRS also generates a Progress Note when an allergy is marked
entered in error. When this note is signed by the user who marked the allergy
as entered in error or by an administrative update user, the note will be
viewable by all CPRS users.
Method Two
Take the following steps to use the second method:
- Click a causative agent (or highlight using
the Tab and arrow keys and press <Enter>) that appears in the
Allergies/Adverse Reactions pane.
CPRS displays a dialog that
contains detailed information about the allergy or adverse reaction. This
dialog includes four buttons.
- Select the Entered in Error button.
CPRS displays the Mark
Allergy/Adverse Reaction Entered In Error dialog.
- If your site has enabled the Comments feature, you may
(optionally) type comments in the Comments (optional) dialog.
- Select OK.
CPRS displays an Are you Sure? dialog.
- If you are sure the causative agent was
entered in error, select Yes.
CPRS removes the causative agent
from the Allergies/Adverse Reactions
pane and from the list of allergies it displays when you select Allergies in the Postings pane.
Note: CPRS also generates a Progress Note when an allergy is marked
entered in error. When this note is signed by the user who marked the allergy
as entered in error or by an administrative update user, the note will be
viewable by all CPRS users.
Reviewing and Creating Postings
Postings contain critical patient-related information about
which hospital staffs need to be aware. The Postings button is visible on all tabs of the CPRS GUI window and
is always located in the upper right corner of the window.
To view a posting using the Postings (CWAD) button, use
these steps:
- Select the Postings button (available from
any tab) to display the Patient Postings dialog.
The Patient Postings dialog
- From the Patient Postings dialog, select the posting in which you
are interested and view the details.
- When finished, select Close.
To view the posting
from the Cover Sheet, use the following steps:
- On the Cover Sheet tab, click on a specific posting that appears in
the Postings pane to display the details.
- When finished, click Close.
Creating Postings
You create the following types of postings by creating
progress notes using note titles that your site’s IRM staff has configured for
this purpose. (Check with your site’s IRM staff if you don’t know which note
titles create which types of postings.)
•
Clinical Warning
(which is the same as Warning)
•
Crisis Note
•
Directive
•
Warning
•
Pregnant
•
Lactating
For example, to create a posting for a crisis note, take the
following steps:
- Select the Notes tab.
- Select New Note. CPRS displays the Progress Note Properties
dialog.
- In the Progress Note Title pane, select CRISIS NOTE.
- In the Date/Time of Note field, select a date.
- In the Author field, select an author.
- Click OK.
- From the main menu, select File | Refresh
Patient Information. CPRS displays the letter C (for crisis note) on the
Postings button and, in the Postings pane on the Cover Sheet Tab, displays
the title Crisis Note and the date you selected for the note.
Allergy: To
create a posting for an allergy or adverse reaction, enter the allergy from
either the Cover Sheet tab or the Orders tab. (See “Entering Allergies”
in the “Assessing,
Entering, and Reviewing Allergies/Adverse Reactions” section
of this manual or “Entering Allergies from the Orders Tab” in the “Orders”
section of this manual, respectively.)
Note: Although
you may be able to enter progress notes for allergies and adverse reactions,
doing so does not create an Allergies
postings. As mentioned above, you can create Allergies postings only by entering allergies via the Cover Sheet
or Orders tab. Furthermore, CPRS cannot perform order checks on allergies you
document via progress notes.
Lactation and Pregnancy: These can be entered in several
locations, including from the Women’s Health pane of the Cover Sheet if it in
configured to display there. If the pane displays, the user can right-click to
display a context menu and then select the Add Data menu item.
The problems list on the Problems tab displays a patient’s
current and historical health care problems entered by clinicians. The problems
list allows each identified problem to be traced through the VISTA system.
Service-Connected Conditions
If a problem is service connected, the problem’s
service-connected status is displayed in parentheses in the Description
column.
Service-Connected Condition Abbreviations
•
SC – Service-Connected
Condition
•
AO - Agent Orange
Exposure
•
IR - Ionizing
Radiation Exposure
•
SWAC - Southwest Asia
Conditions
•
SHD – Shipboard Hazard
and Defense
•
MST - Military Sexual
Trauma
•
HNC – Head or Neck
Cancer
The problems list on the Problems
tab can be configured to show active, inactive, both active and inactive
combined, or removed problems. Treatment factors, SNOMED CT codes, and ICD
codes display right after the problem text
Coding Systems Used to Represent Problems
Problems in CPRS are represented using two systems:
Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) codes and
International Classification of Diseases, Tenth Revision, Clinical Modification
(ICD-10-CM) codes. SNOMED CT terminology is the designated national standard
for Problem List for clinically expressing problems and to support
interoperability and data exchange within VA, DoD, and external partners.
ICD-10-CM codes are primarily used for reimbursement purposes. Previously, only
ICD codes were used to define problems. SNOMED CT should help providers better
define problems, while also mapping to ICD codes in the background.
Depending on the method for documenting a problem, the
problem represented in SNOMED CT may or may not be linked to an ICD-10-CM
code(s). If the user selects a problem from the National Problem Selection
List, the problem will be linked to ICD-10-CM code(s). If the user selects a
problem from within the Lexicon Utility, the problem will be linked to an R69
code (an unspecified problem).
Using Problems for Encounter Information
The Problem List application passes all patients’ problems
to the Encounter Form. These problems can be viewed under the Problem List Item
section of the Diagnosis tab and may be utilized for Encounter check out. However, if the problem is linked to an
inactive code or represented in ICD-9-CM, the system requires the user to
update the problem. Updates may require the user to link the problem to an
active SNOMED CT or ICD-10-CM code.
Customizing the Problems List
You can control which problems appear on the problems list
by defining specific criteria. For
example, you can specify that only inactive problems associated with a specific
clinic appear on the problems list.
To control which
problems appear on the problems list, follow these steps:
- From the Problems tab, click any of the
options listed in the View options field (Active, Inactive, Both active
and inactive, or Removed)
-or-
select View | Active Problems,
View | Inactive Problems, View | Both Active/Inactive Problems, or View |
Removed Problems.
The appropriate problems will
appear on the problems list.
If you would like to filter the
problems list further, continue with step 2.
- Select View | Filters….
The Problem List View Filters
dialog appears.
- Select the criteria for the problems that you want to display on
the problems list by doing some or all of the following:
a.
Select either
Outpatient or Inpatient from the Primary View option group.
b.
Select a status from
the Status drop-down list.
c.
Move the appropriate
source services or source clinics to the Selected Service(s) or Selected
Clinic(s) field by clicking the >
button.
d.
Choose a provider from
the Selected Provider drop-down list.
Note: If the provider has an NPI, it will display on the screen
below. See the "National Provider
Identifier (NPI) Display in CPRS" section for an example of an NPI
displaying on a screen.
You can use the Problem List View
Filters dialog to select the criteria for the problems that you want to display
on the Problems tab
2.
Select OK.
Adding a New Problem
The Problems tab now uses Systematized Nomenclature of
Medicine—Clinical Terms (SNOMED CT) for documenting problems on the patient’s
problem list.
Note: Remember that the diagnosis on the
Encounter form can be added to the Problems tab by simply selecting the
checkbox to put it there.
With the Lexicon search, the initial search contains
frequently used problems within the VA and new problems are added each Lexicon
Quarterly release. The Extended Search represents a larger subset of SNOMED CT
containing all the terms from the Clinical Findings, Events, and Situation with
Explicit Context hierarchies. Currently, all terms are linked to a placeholder
ICD-10-CM code of R69 and may be updated through the Encounter Form
workflow.
To speed up documentation in Problem List and to avoid the
dual entry in the Encounter Form application, enhancements were completed to
enable the use of the VA-National Problem Selection List or a VISN, or local
problem selection list. Sites can use the National Problem Selection List that
has curated Problem Categories with problems represented in SNOMED CT that are
linked to ICD-10-CM code(s). In addition, sites can create Local Problem
Selection Lists. Users or clinics who want to create their own Local Problem
Selection List will need to request this from a Clinical Application
Coordinator (CAC) and will be responsible for maintaining these Local
lists.
It is highly recommended that sites
use the National Problem Selection List because it will be nationally
maintained. The National Problem
Selection List will display by default unless the user or clinic already has a
Problem Selection List defined. The Problem Selection List is displayed in the
left pane of the Add a New Problem dialog.
To add a new problem
to a patient’s problem list, use these steps:
- Select the Problems tab.
- Select the New Problem
-or-
select Action | New Problem…
Note: If
encounter information has not been entered, the encounter information dialog
will appear before the Problem List Lexicon Search dialog. You must complete
the encounter information dialog before proceeding.
If
sites have not assigned a different problem selection list to a user or clinic,
the VA National Problem List Selection list will display as shown above. The
top pane shows the problem categories. Selecting a category will display the
problems in that category in the pane below
- If the user is set
up to use the National Problem Selection List the National Problem
Categories with the associated problem are displayed based on the
category. If the problem is not found within the category, skip to step 4
by selecting Other Problem to bring up the Problem List Lexicon Search
dialog.
The Problem List Lexicon Search dialog enables users to
search for the term that best describes the patient’s problem. SNOMED codes are
used to define the problems.
- Enter part or all of a term that describes
the problem in the Enter Term to Search field and press <Enter> or
select Search.
CPRS
will search the lexicon for problems that contain the search term. The matching
problems will appear in the bottom portion of the Problem List Lexicon Search
dialog. The search now looks for SNOMED Clinical Terms (SNOMED CT). There is
also a parameter to hide the codes if sites so choose
- Select the appropriate term if it is in the
list. If you do not see the appropriate problem listed, select the Extend Search button.
On the Problems tab, the Extend Search button extends the
search to a larger subset of SNOMED CT.
When
the search is extended by the user, more matching results are returned that are
linked to the ICD-10-CM R69. If the user still does not find the desired term,
the user may choose to enter a free text entry by selecting the Freetext
Problem button
- If the user does not
find the desired term using the Extend Search they may choose to enter a
free text entry, the user may choose to do the following actions
To refine your search, select No
and return to step 4. To use this term, select Yes and go to step 7.
o Terms Found But Not Adequate: If the extended search displays
terms, but not the one you want, you will need to decide whether to enter a
free-text term or revise your search.
To begin the search again using
another term, return to step 4 and use another term to identify the
problem.
To enter a free-text term, select
the Freetext Term button. The Unresolved Entry dialog will display as shown
below:
This dialog shows when the system
does not find any terms that match the text entered by the provider or when the
provider selects the Freetext button because an adequate term is not displayed.
From the Unresolved Entry dialog, the provider can choose to use the term as
entered, and if needed, request that it be added as a new term
To use this term, you first need to
decide if you want to request that the term you entered be added as a new term.
To request a new term, you need to check the Request New Term check box and add
a comment if needed. If not, leave the check box unchecked. Then, to add this
term to the Problem List as entered, select Yes and go to step 10.
Note: If
you request a new term, a bulletin is sent to a local group for review. This
group will then forward the request if it concurs that a new term is needed.
o No Terms Found: If the extended search finds no terms, the
Unresolved Entry dialog will display as shown below. To try another search,
select No and return to step 4.
The New Problem form will appear.
The New Problem form
- Complete the New Problem form by following the steps below:
a.
Select a status for
the problem (Active or Inactive).
b.
Choose an Immediacy
for the problem (Acute, Chronic, or unknown).
c.
Enter the date of
onset.
d.
Select a responsible
provider from the drop-down list.
e.
Select a clinic from
the drop-down list.
f.
Check any applicable
treatment factors that apply to this problem.
g.
Enter any comments (if
necessary) by pressing the Add comment
button. You can also edit a comment or remove the comment using the appropriate
buttons.
- Select OK.
Annotating a Problem
To annotate a problem, use these steps:
- Select the Problems tab.
- Select a problem from the problems list.
- Select Action | Annotate... or right-click
the problem and select Annotate... from the pop-up menu.
Note: If you try to select a problem that has an inactive diagnosis
or procedure code, you will be prompted to select a problem with an active
code.
- Enter your annotation in the dialog that appears (up to 60
characters).
- Select OK.
Changing a Problem
To change a problem on a patient’s problem list, use these
steps:
- Select the Problems tab.
- Select a problem from the problems list.
- Select Action | Change….
- Enter the desired changes.
- Add or remove a comment (if desired).
Note: A comment can be as many as 60
characters (including spaces) in length.
- Select OK.
Note: When you view the details of a problem, you will see who
changed the problem and when.
Making a Problem Inactive
To inactivate a problem on a patient’s problem list, use the
following steps:
- Select the Problems tab
- Select a problem from the problems list.
- Select Action | Inactivate -or- right-click
a problem and select inactive.
Removing a Problem
To remove a problem from a patient’s problem list, use these
steps:
- Select the Problems tab.
- Select a problem from the problems list.
- Select Action | Remove or right-click the
problem and click Remove.
Note: Deleted
problems are not actually removed from the database. Rather, a deleted problem
is flagged with a hidden tag. The hidden tag prevents the problem from
appearing on any reports or lists.
Verifying a Problem
To verify a problem on a patient’s problem list, use these
steps:
- Select the Problems tab.
- Select a problem from the problems list.
- Select Action | Verify or right-click the
problem and click Verify on the pop up menu.
Note: If you try to select a problem
that has an inactive diagnosis or procedure code, you will be prompted to
select a problem with an active code.
The Meds tab contains a list of medications for the selected
patient. Inpatient, outpatient, and Non-VA (including non-prescription and
herbal) medications are listed in separate sections of the window.
When you select the Meds tab, you see a list of medications
that have been ordered for this patient. If you would like to view additional
information about a specific medication, double click the medication entry or
select a medication and choose View |
Details.
Note: You can also review or add medication
orders from the Orders tab. Also, if a medication is preceded by an asterisk
(*), the asterisk indicates that the order was changed as a service correction.
The Meds tab shows three different
sections: Inpatient Medications, Non-VA Medications (Documentation), and
Outpatient Medications as shown below. Directly below the Patient Inquiry
button, CPRS displays the sort method for the Meds tab--in this case, “Sort by Status/Exp. Date (first on
Inpt)”. CPRS will display the date range
for the medications viewed under each section (Inpatient Medications, Non-VA
Medications, and Outpatient Medications). Users should always check these
lines.
The Meds tab
Medication Details
If you would like to view additional information about a
medication, double click the medication entry or select a medication and choose
View | Details.
Medication Administration History
You can view the administration history for a medication in
three ways:
o
Double-click a
medication. The administration history will be listed at the bottom of the
details screen.
o
Select a medication
and then select View | Administration
History.
o
Select a medication
and then right-click. Choose Administration
History from the pop-up menu.
Other Medication Actions (popup menu)
To take other actions, such as ordering a new medication,
changing a medication order, or changing a medication order status
(discontinue, hold, or renew), you use the Action menu or right-click a
medication to display a popup menu. You can also place orders for new
medications from the Orders tab.
Note: When a user takes actions on an order, such
as renewing, changing, or discontinuing it, an infrequent error sometimes
occurs where the order number in CPRS and the order in Pharmacy do not match.
In this case, CPRS displays a warning that there is an “invalid pharmacy order
number” and instructing the user to contact someone in the Pharmacy service to
complete the action.
Using the right-click or popup menu on the Meds tab, if the
user selects several items and the right-clicks either on the items or
elsewhere in the list, CPRS displays a popup menu. When the user selects an
action from the popup menu, the action applies to all selected items. For
example, if the user selects three inpatient medication orders and selects
Discontinue, the dialog appears with those three orders listed for
discontinuation.
However, if no items are selected (highlighted in blue) and
the user right-clicks on an item, it is selected and the popup menu appears. In
addition, CPRS treats each section, Inpatient, Non-VA meds, and Outpatient, as
a unique area so that if the user has an item selected in, for example,
Outpatient, and then right-clicks on an inpatient medication, the outpatient
selected will be deselected and the inpatient item will be selected and the
popup menu displays.
The popup menu includes the following items:
o
Details…
o
Administration
History…
o
Change…
o
Discontinue…
o
Refill…
o
Renew…
o
New Medication…
Indications
The Computerized Patient Record System (CPRS) enables
providers placing medication or prescription orders to enter an indication for
use. For example, the indication for Coumadin might be blood thinning.
Indication is now a required field for medication orders in
CPRS. It is not a required field for Non-VA documentation nor Supply orders. An
indication identifies the main reason that the medication is being given. The
Indication entered can also be included on the medication label if the pharmacist
elects to put it there.
CPRS works with the Pharmacy package to enable set up of
indications in Pharmacy that will then display in CPRS for a provider to select
when ordering. The set up enables sites to designate a primary and secondary
indications.
New Field on Medication Order Dialogs
Once indications have been set up, the primary indication
and secondary indications will display in a drop-down box on appropriate CPRS
order dialogs. When the provider places an order or takes an action, such as transferring,
the provider can select one indication for the order. The primary indication as
shown, displays first, then there is a separator line, and then the secondary
indications display below the line and are sorted in alphabetical order. The
provider can also type in an Indication if they so choose.
CPRS dialogs
that have the Indication field include the following:
●
Inpatient Medications
●
Outpatient Medications
●
Clinic Medications
●
Clinic Infusions
●
Non-VA Documentation
(not a required field)
●
Supply Items (not a
required field)
●
Indications on Order Details
Once the order has been placed, the indication will show on
the Order Details.
Indication Displays on Reports where SIG Is
Displayed
The Indication displays on reports where the SIG is displayed.
There is an example below.
Order Checks
Order Checking is based on a system of rules that reviews
orders to see if they meet defined criteria. If they meet the criteria, an
electronic message is sent to the ordering provider to alert the provider to a
potential problem (such as creatinine clearance, polypharmacy, duplicate order,
drug-lab interaction, etc.). The provider can then choose to cancel the order
or override the order check and place the order.
The Order Checking system gives users and clinical
application coordinators (CACs) some flexibility to determine which order
checks and notifications are sent and whether the provider must enter a reason
to override the order check. To accomplish this, CPRS includes several
prepackaged order checks as well as three menus for setting Order Checking
parameters such as enabling and disabling specific order checks. Order Checks
can also be configured to be mandatory by the Clinical Coordinator or IRM. If
this feature is enabled, users cannot indicate that they do not want to receive
individual order checks. Non-mandatory order checks can be enabled or disabled
through the Tools | Options menu.
CPRS calls for order checks on all orders. CPRS calls for
order checks at the following times:
o
When the user opens
the order dialog by selecting an item from the Write Orders pane or from an
order menu
o
In the order dialog
when the user selects Accept Order
o
When the user selects
a sign action—before the user signs
CPRS uses three kinds of order checks: site-defined Clinical
Reminder order checks, nationally released local orders checks, and remote
orders checks between sites.
Site-Defined Clinical Reminder Order Checks
CPRS enables sites to create their
own order checks based on the Clinical Reminders features. Sites will define a
group of orderable items for which certain rules apply. If the rules apply to
the situation, the site can define text that will display in the order check
window. Sites can also set the order check to require an override.
Setting Up Clinical Reminder Order Checks
Clinical Reminder order checks are defined at the site by
those who normally work on the Clinical Reminders package. The set-up of a
Clinical Reminders Order Check consists of two parts:
o
Creating a group of
orderable items to which the rules should apply.
o
Creating the rules
that will be applied to the orderable item when accepting an order in
CPRS. It will be possible to have the
same orderable item in multiple groups. Each rule assigned to the different
groups will be evaluated when placing the orderable item in CPRS. The order
check groups and the rule will be stored in the Reminder Order Check file.
Rules can either be defined to run against a reminder term
or a reminder definition. A reminder term is beneficial when the request is to
evaluate the presence of specific data (See Example #1). A reminder definition
is beneficial if you need the full functionality of a reminder definition to
determine if the rule should show in the order check form (See Example #2). The
user setting up the Clinical Reminder order check can define only one or the
other.
Note: Sites should evaluate all requests to
create a Clinical Reminder Order Check to determine the importance of adding
it. The more reminders that are used in an order check, the more they could
affect the performance of the order check system.
Example
#1
Problem: An order check is needed for the interaction
between timolol ophthalmic (used to treat glaucoma) and over-the-counter (OTC)
antihistamines (which should not be used in the rarer narrow angle glaucoma).
Setup:
- Create a reminder term that looks for the presence of a diagnosis
of narrow angle glaucoma. (May need to look at multiple files depending on
your site practice)
- Create an Orderable Item Group that contains all orderable items
for any OTC Antihistamines.
- Create a Rule that contains the term created in step 1.
- Set the rule to trigger the order check if the reminder term is
evaluated at True.
- Create the text that should appear in the
order check window.
Example of the Output in CPRS
This
is an example of a Clinical Reminders order check
Description of solution: A reminder term was used in the
setup because the presence of Glaucoma was all that is needed to determine if
the rule should trigger an order check. In the screen shot above, the text
"Diagnosis of Glaucoma" was defined in the Display Name field. The
rest of the text was defined in the Order Check Text field.
Example #2
Problem: Order Check is needed when ordering Glyburide for
patients age 65 or greater and serum Cr 2.0 or greater.
Setup:
- Create a reminder definition that is applicable to the patient if
the patient age is 65 or greater and the patient has a CR serum 2.0 or
greater.
- Create an Orderable Item Group that contains all orderable items
for the Glyburide.
- Create a Rule that contains the definition created in step 1.
- Set the rule to trigger the order check if the reminder definition
is applicable to the patient.
- Create the text that should appear in the
order check window. Set the order text to display the finding output in
the order check text.
Example of the output in CPRS
This
is an example of a Clinical Reminders order checks that uses a rule and
contains part of the definition
Description of solution: We needed a reminder definition to
match patients older than 64 who had a lab test with the results greater than
2. In this example we set the rule up to display both the order check text and
the definition evaluation text. The text “Glyburide Contraindicated” is the
display name. The text “Avoid glyburide in patients with a calculated
creatinine clearance < 50 ml/min or a creating 2 or greater. If an oral
sulfonylurea is required, consider glipizide,” is defined by the site. The rest
of the text is returned from the reminder definition evaluation.
Enabling Users to See the Reminders Order Checks
Clinical Reminder Order checks are defined with a testing
field. If the order check is being tested, the Clinical Application Coordinator
(CAC) or similar person sets this field in the Clinical Reminders order check
definition to True. Then, only users who have the Clinical Reminder Test order
check set to Yes will receive the order check—allowing a small number of users
to test the order check before it is enabled for all users in the facility.
Local Order Checks
These nationally released order checks are available on a
local CPRS system:
o
Allergy-Contrast Media
Interaction
o
Allergy-Drug
Interaction
o
Aminoglycoside Ordered
o
Biochem Abnormality
For Contrast Media
o
Clinical Reminder Live
o
Clinical Reminder Test
o
Clozapine
Appropriateness
o
Critical Drug
Interaction
o
CT & MRI Physical
Limitations
o
Dangerous Meds For Pt
> 64
o
Dispense Drug Not
Selected
o
Drug Dosage
o
Duplicate Drug
o
Duplicate Drug Class
Order
o
Duplicate Opioid
Medications
o
Duplicate Order
o
Error Message
o
Estimated Creatinine
Clearance
o
Glucophage-Contrast
Media
o
Glucophage-Lab Results
o
Lab Order Freq
Restrictions
o
Missing Lab Tests For
Angiogram Procedure
o
No Allergy Assessment
o
Order Checking Not
Available
o
Polypharmacy
o
Recent Barium Study
o
Recent Oral
Cholecystogram
o
Renal Functions Over
Age 65
o
Significant Drug
Interaction
Several parameters that each site controls determine how
these order checks behave.
Order Check on Acceptance Dialog
For medication orders, if a possible problem is found, CPRS
displays the order check window, such as seen below when the user selects
Accept:
When
accepting a medication order, order checks are performed to identify potential
problems
The Order Checking dialog separates each order check text,
which is numbered using the “1 of 2, 2 of 2” type of format. If an allergy assessment has been done, the
Perform Allergy Assessment button will be inactive.
Order Checks Dialog on Signature Actions
If the clinician chooses to sign the
order, CPRS displays the following dialog:
In
this screen capture, CPRS displays conflicts between ordered medications. Users
should review each item carefully before completing the order. If an order
check is larger than the cell’s available space, the user can either hover with
the mouse to the get the full text, use the arrow keys to highlight the order
check if using the keyboard or use an accessibility product for the visually
challenged. Some order checks require an override reason. These order checks
are designated by the “*Checks marked with **** require reason for override”
text in red and the order check text in blue.
This dialog displays each medication or other item that had an
order check in a separate section. Each item will have a check box allowing the
user to check any orders that should be canceled at this point. Under the order
text, the order checks are displayed, the most serious order checks are listed
first. Those with High Clinical Danger Level items are displayed first, labeled
as high danger, and are displayed with blue text. To accept these orders, the
clinician must enter an override reason to justify accepting the order.
Whether the order check requires the clinician to enter a
justification depends of how each site has set the Clinical Danger Level for
each order check. For example, the Pharmacy package determines if an
interaction is critical or significant. Each site then determines whether the
provider must enter a reason for override by setting a Clinical Danger Level in
CPRS for the Critical Drug Interaction and Significant Drug Interaction order
checks.
Another example would be allergy assessments. If the site has
set the No Allergy Assessment order check
Clinical Danger Level to High and the patient does not have an allergy
assessment, then the order will require a justification for override. If the
site has set the Clinical Danger Level to Moderate, no reason is required.
When a user enters a high clinical danger level override
reason, the reason for override is sent with the orders to ancillary packages
so that the information is available to their users.
The dialog also has a View Monograph button. Selecting the
View Monograph button will send the user to a monograph about the drug or drug
class to help the provider with additional information. If there is more than
one kind of drug, the Monographs for Order Checks dialog will display a
dropdown list with the choices for the various kinds of medications.
Remote Order Checks
In addition, with the Remote Data Interoperability (RDI)
project, it is now possible to perform a limited number of order checks against
remote outpatient pharmacy and allergy information from other Veterans Health
Administration (VHA) facilities that is stored in the Health Data Repository
(HDR). Another project, the Clinical Health Data Repository (CHDR) will enable
remote order checks against allergies and outpatient medication data from
Department of Defense (DoD) facility data that is stored in the HDR. The CHDR
data only relates to active dual consumers (patients that are seen at both VHA
and DoD facilities).
For the selected patient, RDI requests from the HDR all
outpatient pharmacy data with an expiration or discontinued date starting 30
days in the past and going forward, including into the future.
What Remote Order
Checks Are Available?
With RDI and CHDR, the following order checks occur:
o
Allergy Contrast Media
Interaction
o
Allergy-Drug
Interaction
o
Critical Drug
Interaction
o
Duplicate Drug Class
Order
o
Duplicate Drug Order
o
Significant Drug
Interaction
Which Items Are NOT
Used in Remote Order Checks?
Some items are not used in remote order checking because they
are not stored in the HDR. Others have a high annoyance factor and therefore
were not included at the request of field sites. The following items are not
included in remote order checks:
o
Inpatient Medications
o
Non-VA Meds
o
Supply items
o
Local drugs that are
not matched to the National Drug File
Note: The HDR-Hx and HDR-IMS contain prescriptions
with drugs that are not matched to the National Drug File (NDF). This
prescription data should be used in remote order checking for duplicate drug
classes. Because the National Drug File is updated regularly, these missing
order checks could be resolved whenever the NDF is updated. Some drugs may
never be matched, especially drugs used in research.
Will the Display Change?
With RDI, if there is a problem with an order check, CPRS
displays the information to the user potentially in two separate dialogs. The first dialog displays the allergy order
checks:
● It displays the facility name where the allergy was
recorded, the reactant, signs, severity, and symptoms.
● For remote allergies, the user is required to give a reason
for overriding order checks. The user is also able to write a local comment on
a remote facility allergy.
● Allergies are sorted by clinical danger level:
o
In cases where allergy
severity and symptoms are identical in one or more order checks, a single
consolidated order check will display. The sort order hierarchy is:
▪ First by Severity (Highest to Lowest).
▪ Second by Causative Agent.
▪ Last by Local and Remote locations.
The second dialog displays the following information:
●
Medication orders
include the last refill date and the quantity.
● Remote medication order checks display the facility name
where the medication was prescribed. Local medication order checks do not
display the facility name.
The
screen capture above shows order checks with remote facility names listed.
If CPRS receives no data from the HDR, it will display the message
“Remote Order Checking not available – checks done on local data only,” as
shown in the screen capture above.
CPRS shows this message once during
an ordering session when it cannot communicate with the HDR and then does not
show it again until the user begins another ordering session. However, after
displaying the message, CPRS continues to attempt communication with the HDR.
If CPRS reaches the HDR, remote order checks will appear when orders are
placed.
How Is RDI Remote Order Checking Enabled?
To use remote order checking, your site must enable a
parameter to access HDR data. This parameter is set for the entire facility.
When Does CPRS Get Remote Data?
Order checks from CPRS can happen several times during a
CPRS ordering session:
o
Beginning to
write/copy/change orders – When a user selects an order menu to begin writing
orders, CPRS requests some order checks, such as polypharmacy, renal function,
or creatinine clearance, for example.
o
On order acceptance –
When the user selects Accept, CPRS requests the order checks.
o
Signature of orders –
When a user signs the order, CPRS requests order checks.
How Long Is the Data Used?
A parameter that sites can set controls how long HDR data is
stored locally and is considered “fresh” and can be used for order checks
before the data will be retrieved again from the HDR. The default time for this
parameter is 120 minutes or two hours, but each site can change the time in
that parameter.
Sorting the Medications View
CPRS enables users to get different views of the medications
a patient is taking based on different sorting criteria. CPRS remembers the
value selected by the user for the Meds tab sort. The first time a user signs
into CPRS 27 the Meds tab will default to the original sort. The sort name will
be display on the meds tab.
The first format is the existing functionality and is sorted
by Location, then by Status Group, then by Stop Date/Expiration Date.
The existing functionality uses the following status groups:
o
Pending
●
NON VERIFIED
●
NON-VERIFIED
●
PENDING
o
Active/Hold
●
ACTIVE
●
ON CALL
●
REFILL
●
REINSTATED
●
RENEWED
●
SUSPENDED
●
HOLD
●
PROVIDER HOLD
●
DONE
●
DRUG INTERACTIONS
o
Expired
●
EXPIRED
o
Discontinued/Deleted
●
DATE OF DEATH ENTERED
●
DELETED
●
DISCONTINUED
●
DISCONTINUED (EDIT)
●
DISCONTINUED (RENEWAL)
●
DISCONTINUED BY
PROVIDER
●
PURGE
●
PARKED
The first new view is sorted by
Status Group, then by Status, then by Location, then by Drug Name. The first
new view uses the following Status Groups:
o
ACTIVE
▪
Active
▪
Refill
▪
Hold
▪
Suspended
▪
Provider Hold
▪
On Call
▪
Parked
o
PENDING
▪
Non-verified
▪
Drug Interactions
▪
Incomplete
▪
Pending
o
DISCONTINUED
▪
Done
▪
Expired
▪
Discontinued
▪
Deleted
▪
Discontinued By
Provider
▪
Discontinued (Edit)
▪
Reinstated
▪
Renewed
The second new Meds tab view within CPRS is sorted
alphabetically by Drug:
o
Sort by drug name
o
Status active
o
Status recent expired
(using ORCH context meds stop date)
Medications will sort Inpatient, Outpatient, and Non-VA meds. Each group will sort
in their own section on the CPRS Meds tab.
To sort the medications, use these steps:
- Select the Meds tab.
- Select the appropriate sorting method:
o
Sort by Status/Exp
Date (Clinic Orders first on Inpt)
o
Sort by Status
Group/Status/Location/Drug Name
o
Sort by Drug
(alphabetically)/status active/status recent expired
Ordering Inpatient Medications
Ordering medications uses two dialogs in the ordering
process and eliminates the dispense drug prompt. Inpatient medication orders
now require a valid schedule. If users do not find the appropriate schedule in
the list, they can choose to create a day-of-week/administration time schedule
using the new Schedule builder. This feature also works for
renewing and changing inpatient medication orders.
Note:
Because a valid schedule is required,
if you attempt to modify an existing medication order that does not have a
valid schedule, you will receive a message box stating that and will have to
enter a valid schedule. CPRS now requires a unique match in the Medication,
Dosage, Route, and Schedule fields for inpatient medications before CPRS will
auto-select an item from the list. For inpatient medications, the Medication
and Schedule fields must be an item from the list, but the Dosage and Route can
be a free-text entry (the route must be in the MEDICATION ROUTES file #51.2).
If the desired schedule is not on the list, the user can build a
day-of-week/administration time schedule using the Schedule Builder.
CPRS displays unit dose routes based on the following rules:
- If a default medication route is defined in the orderable item
file, CPRS displays only the default medication route for the Unit Dose
orderable item in the medication route selection list.
- If there is no default medication route defined for the orderable
item, CPRS displays all possible medication routes for the dosage form to
the provider for selection.
- If there is only one possible medication route, it will be used as
the default.
- If a medication route name or its
abbreviation is not included in the selection list, a user may type it in.
Also, medications that are not in the formulary display in
the list with the letters “NF” after the name or synonym, which is also
displayed. CPRS checks for nonformulary dosages (e.g., the VA formulary may not
have a 2.5 MG pill, but it may have a 5.0 MG pill) and for non-formulary
orderable items (e.g., the VA may not carry a specific kind of allergy
medication).
Clozapine Requirements
See Section New Clozapine
Requirements for more information about ordering clozapine.
Simple Dose
Note: If
the user attempts to order inpatient medications for an inpatient from an
outpatient location, CPRS discontinues the order process and returns the user
to original Orders or Meds tab display.
To write a new simple dose Inpatient Medications order, use
these steps:
- Select the Meds tab and then select Action
| New Medication.
-or-
select the Orders tab and bring up the inpatient dialog by selecting the
appropriate item in the Write Orders pane. CPRS displays the Medication Order
dialog as show in the graphic below.
The Inpatient Medications order
dialog allows you to select from a list of personal quick orders or medications
- Locate the desired medication or medication
quick order by typing characters in the Medication field.
Note: CPRS now only
auto-selects (highlights in blue and places that entry in the field) a
medication, dosage, route, or schedule if the user types enough characters to
uniquely identify an item in the list. If the user does not enter enough
characters to uniquely identify an item, CPRS waits until the user manually
selects an item using the mouse or the keyboard.
- Select the quick order or medication name.
Once the name is selected, CPRS displays a second dialog to select the
items for the rest of the order. In the top field of the second dialog,
the generic medication name and the synonym (usually a brand name) are
displayed.
The lab results for the most recent
lab test associated with the selected medication are displayed in the
Information field, if an associated lab test was performed within the last 365
days.
Note: A CAC or ADPAC will
need to set the OR CPRS LAB DISPLAY ENABLED parameter to ON to activate the lab
results display at a site.
To view
associated lab results for Quick Orders, a TIU OBJECT must be inserted into the
Quick Order. For more information, refer to the Text Integration Utility (TIU)
Clinical Coordinator & User Manual. This functionality will work for
generalized Quick Orders only (orders assigned to Order Menus). It is not
currently implemented for personal Quick Orders.
The lab results functionality will
not work properly for multidivisional facilities or any sites that use
different lab test names at different sites, as only one lab test name can be
associated with each drug. To successfully implement this functionality, all
facilities/divisions that share a VistA system must use the same name for each
monitored lab test.
Note: CPRS now uses a look
up from Pharmacy to determine whether the selected medication is a controlled
substance that requires the signature of a provider with a DEA or VA number.
For controlled substances, CPRS displays a message—“Order for controlled substance
could not be completed. Provider does not have a current, valid DEA# on record
and is ineligible to sign the order”—as shown in the graphic below. CPRS allows orders for controlled substances
only when selected providers are able to sign the orders. You may need to exit
the dialog, change the provider selection, and then reenter the dialog. See Appendix D: Error Messages and
Troubleshooting for a full list of error messages related to controlled
substance ordering.
You must have a DEA# or VA# to order certain
medications
Note:
CPRS requires a patient to have a valid address if the selected
outpatient medication is a controlled substance that requires the signature of
a provider with a DEA number. For outpatient controlled substances, CPRS
displays a message – “Controlled substance prescriptions require a patient
address. Please contact administrative support to update patient address
information.” if the patient does not have a valid address. The contact
information in the display may be customized using the Enter/Edit Missing ZIP Code Message option in the GUI Parameters
menu.
Controlled substance prescriptions
require a patient address.
- In the Dosage field and select or type a
dosage.
The dosage may not begin with a
decimal, for example .5; it must begin with a numerical value, 0.5 for example.
Also, the character “^” may not be entered in the Dosage field. Also, the
associated cost of the drug is displayed to the right of the dosage.
Note: CPRS now only
auto-selects (highlights in blue and places that entry in the field) a
medication, dosage, route, or schedule if the user types enough characters to
uniquely identify an item in the list. If the user does not enter enough
characters to uniquely identify an item, CPRS waits until the user manually
selects an item using the mouse or the keyboard.
Once a dosage is selected, any lab
test results displayed in the Information field are replaced by the National
Standard Orderable Item information.
- In the Route field, enter the appropriate route (a default route
may have been set up) by either selecting one from the list or typing in a
valid route.
- In the Schedule pane, select an existing
schedule from the list or, to use a day-of-week/administration time
schedule not on the list, select OTHER (you can also click the
Non-Standard? link and then click OK on the dialog that displays).
When the user selects a schedule,
the administration times may display under the “Give additional dose now” text.
The administration times will display if they have been defined for the ward or
if there is a default as long as the order is not a PRN order.
- If you selected an existing schedule, skip to step 8. If you
selected OTHER, the Order with Schedule ‘OTHER’ dialog appears. Take the
following steps:
a)
Select one or more checkboxes
by the appropriate days of the week.
b) If the schedule requires specific administration times skip
to steps c and d. To select a schedule from the list, highlight the schedule
and select Add.
Note: Users can assign either a schedule from the list or specific
administration times, but not both. Also, because the user is specifying days
of the week and a schedule, the list will contain only schedules less than 24
hours (for example, Q36H will not be in the list).
c)
To use a specific
administration time, select the hour and minutes (if the user only selects the
hour, the minutes will default to zero) and select Add.
d)
Repeat step c until you have
entered all required administration times.
Warning: The administration times in the Schedule field apply to
each day of the week that is listed, such as TU-TH-SA@08002000, for example. To
create a schedule such as TU@0800 TH@2000, users would have to enter two
separate orders using the complex medication order dialog. Also, users may not
enter a schedule that only has administration times and PRN but no days.
e)
If you make a mistake while
selecting an administration time or schedule, do one of the following to remove
it:
- For
a single administration time, highlight the hour and minutes in the Set
Administration Time fields and select Remove
(so to remove 08:00, you would have to select that time in the Set
Administration Time fields not in the Schedule text box.)
- To remove the schedule, highlight the schedule and select Remove.
- To remove the entire schedule and begin again with step a, select Reset.
f)
Review the Schedule field.
g)
When you have the correct
schedule, select OK.
The Order with Schedule ‘OTHER’ dialog allows you to enter a customized
day-of-week and/or administration-time schedule. The user can enter specific
administration times or select a schedule from the available list
- Select PRN if necessary.
PRN will
display in the schedule field if the PRN checkbox is checked or if the schedule
is defined in the Pharmacy files as a PRN schedule.
- Enter an Indication. If indications have been set up,
there will be items in the drop-down list, the most common indication on
top. If no indications have been set up, you can type an indication
- Add comments (optional).
- CPRS displays the date and time of the
expected first dose if it can determine one. (For example, CPRS cannot
show an expected first dose for “on call” or schedules with PRN. On the
complex tab, it will not try to determine an expected first dose after a
THEN because the first item must be completed.) If you want to give an
additional dose now, select the Give additional dose now check box.
Note: Ensure the “Give
additional dose now” and the regular order you entered do not overmedicate the
patient. “Give additional dose now” is not available for ONCE, ONE-TIME, or NOW
orders. It is also not available for delayed orders.
When you select the Give additional dose now check box,
CPRS creates two new orders. Depending on your version of CPRS, the order
priority and dosing schedule may be set automatically or may require manual
adjustments. The pop-up messages displayed will also vary.
1.
The dosing schedule
and priority are set automatically for each order. The first order is scheduled
for immediate administration (NOW) and is assigned the priority ASAP. The
second order is given the priority ROUTINE and will be administered following
the dosing schedule that you defined. A warning displays that is similar to the
following example.
Note: If your site does not use the priority ASAP,
then an alternative priority (for example, STAT) will display in place of ASAP.
Warning displayed when “Give
additional dose now” is selected
1.
Check the warning
message to ensure that the orders you created are what you expected. If the
orders are acceptable, then click OK. If not, click Cancel to clear the Give
additional dose now check box.
2.
Click the drop-down
arrow and then select a value for the Priority field.
a.
When Give additional dose now is selected,
the Priority field is automatically
set to ASAP (or a site-specific alternative). If you select a value for the Priority field before you select the Give additional dose now checkbox, a
message notifies you that the selected priority will be changed to the “Give
additional dose now” priority settings.
CPRS displays a notification that
“Give additional dose now” overrides any previously selected priority
b.
The default value of
ASAP can be changed by selecting a different value from the Priority field before submitting the
order. If the Priority field is
empty when the order is submitted, it will revert to the default values for
“Give additional dose now.”
- Select Accept Order.
Note: If you do not complete the mandatory items or
if the information is incorrect, CPRS sends a message that tells you the
information is incorrect and shows you the correct type of response.
- (Conditional) If the medication ordered may be contraindicated
because of allergies, drug interactions, or duplicate orders, CPRS will
display the Order Check window. Carefully review all order checks and
decide if the medication should be ordered. Do one of the following:
o
To proceed, select
Accept Order.
o
To stop the ordering
process and return to the dialog, Cancel Order.
- Enter another medication order or click
Quit.
Note: CPRS requires a signature before it sends the
order to pharmacy. You can either sign the order now or wait until later. When
using Give additional dose now, it is recommended that you sign the order
immediately to send the order to the inpatient pharmacy. You only need to sign
once for both orders created when Give additional dose now is selected.
Complex Dose
Note: If the user attempts
to order inpatient medications for an inpatient from an outpatient location,
CPRS discontinues the order process and returns the user to original Orders or
Meds tab display.
In a complex dose order, the user must define specific
characteristics for the order. Because the dose can affect the quantity, for
example, changing certain fields may cause the quantity field to either
recalculate or reset to zero to force the user to enter the quantity.
To write a new
complex dose Inpatient Medications order, use these steps:
- Select the Meds tab and select Action | New
Medication.
-or-
select the Orders tab and
bring up the inpatient Medication Order
dialog by selecting the appropriate item in the Write Orders pane.
- Locate the desired medication or medication
quick order by typing characters in the Medication field.
Note: CPRS
now only auto-selects (highlights in blue and places that entry in the field) a
medication, dosage, route, or schedule if the user types enough characters to
uniquely identify an item in the list. If the user does not enter enough
characters to uniquely identify an item, CPRS waits until the user manually
selects an item using the mouse or the keyboard.
- Select the quick order or medication name.
Once the name is selected, CPRS displays a second dialog to select the
items for the rest of the order. In the top field of the second dialog,
the generic medication name and the synonym (usually a brand name) are
displayed.
The lab results for the most
recent lab test associated with the selected medication are displayed in the
Information field, if an associated lab test was performed within the last 365
days.
Note: A CAC or ADPAC will
need to set the OR CPRS LAB DISPLAY ENABLED parameter to ON to activate the lab
results display at a site.
To view associated lab results for
Quick Orders, a TIU OBJECT must be inserted into the Quick Order. For more
information, refer to the Text
Integration Utility (TIU) Clinical Coordinator & User Manual. This
functionality will work for generalized Quick Orders only (orders assigned to
Order Menus). It is not currently implemented for personal Quick Orders.
The lab results functionality will
not work properly for multidivisional facilities or any sites that use
different lab test names at different sites, as only one lab test name can be
associated with each drug. To successfully implement this functionality, all
facilities/divisions that share a VistA system must use the same name for each
monitored lab test.
Note: CPRS now uses a look up from Pharmacy to
determine whether the selected medication is a controlled substance that
requires the signature of a provider with a DEA or VA number. For controlled
substances, CPRS displays a message—“Order for controlled substance could not
be completed. Provider does not have a current, valid DEA# on record and is
ineligible to sign the order”—as shown in the graphic below. CPRS allows orders
for controlled substances only when selected providers are able to sign the
orders. You may need to exit the dialog, change the provider selection, and
then reenter the dialog. See Appendix D:
Error Messages and Troubleshooting for a full list of error messages
related to controlled substance ordering.
You must have a DEA# to order
certain medications
Note: CPRS requires a
patient have a valid address if the selected outpatient medication is a
controlled substance that requires the signature of a provider with a DEA
number. For outpatient controlled substances, CPRS displays a message –
“Controlled substance prescriptions require a patient address. Please contact
administrative support to update patient address information.” if the patient
does not have a valid address. The contact information in the display may be
customized using the Enter/Edit Missing ZIP Code Message option in the GUI
Parameters menu.
Controlled
substance prescriptions require a patient address
- Select the Complex dose tab.
Note: After you begin a
complex order, you must remain on the Complex tab until you finish the order.
Do not attempt to start from or switch back to the Dosage tab. If you do, all
complex dosages will be erased and you will be forced to start again.
- In the Dosage
field, select or type the appropriate dosage.
The dosage may not begin with
a decimal, for example .5; it must begin with a numerical value, 0.5 for
example. Also, the character “^” may not be entered in the Dosage field. (The
associated cost is displayed to the right of the dosage.)
Note: CPRS now only
auto-selects (highlights in blue and places that entry in the field) a
medication, dosage, route, or schedule if the user types enough characters to
uniquely identify an item in the list. If the user does not enter enough
characters to uniquely identify an item, CPRS waits until the user manually
selects an item using the mouse or the keyboard.
Once a dosage is selected, any
lab test results displayed in the Information field are replaced by the
National Standard Orderable Item information.
- In the Route field, enter the appropriate delivery route for the
medication (a default route could have been set up) by either selecting
one from the list or by typing a valid route.
- In the Schedule field, select an existing schedule from the list
or, to use a day-of week/administration time schedule not on the list,
select OTHER.
- If you entered an existing schedule, skip to step 9. If you
selected OTHER, CPRS displays the Order with Schedule ‘OTHER’ dialog. Take
the following steps:
a.
Select one or more
checkboxes by the appropriate days of the week.
b.
If the schedule
requires specific administration times skip to steps c and d. To select a
schedule from the list, highlight the schedule and select Add.
Note: Users can assign
either a schedule from the list or specific administration times, but not both.
If launched from the Complex tab, the Day-of-Week Schedule builder does not
display one-time schedules in the schedule list. Also, because the user is
specifying days of the week and a schedule, the list will contain only
schedules less than 24 hours (for example, Q36H will not be in the list).
c.
To use a specific
administration time, select the hour and minutes (if the user only selects the
hour, the minutes will default to zero) and select Add.
d.
Repeat step c until
you have entered all required administration times.
Warning: The administration times in the Schedule field apply to
each day of the week that is listed, such as TU-TH-SA@08002000, for example. To
create a schedule such as TU@0800 TH@2000, users would have to enter two
separate orders using the complex medication order dialog. Also, users may not
enter a schedule that only has administration times and PRN but no days.
e.
If you make a mistake
while selecting an administration time or schedule, do one of the following to
remove it:
o
For a single
administration time, highlight the hour and minutes in the Set Administration
Time fields and select Remove (so to
remove 08:00, you would have to select that time in the Set Administration Time
fields not in the schedule text box.)
o
To remove the
schedule, highlight the schedule and select Remove.
o
To remove the entire
schedule and begin again with step a, select Reset.
f.
Review the Schedule
field.
g.
When you have the
correct schedule, select OK.
The Order with Schedule ‘OTHER’ dialog allows you to enter a customized
day-of-week and/or administration-time schedule. The user can enter specific
administration times or select a schedule from the available list
- Select PRN if necessary.
PRN will display in the
schedule field if the PRN checkbox is checked or if the schedule is defined in
the Pharmacy files as a PRN schedule.
- Select the Duration
field. Enter a number and select units (the default unit is days) a
patient should use the specified dose.
- Add the appropriate conjunction: And, Then,
or no conjunction for the final line.
Note: The conjunction
“Then” requires a duration to be added.
- Select the Dosage field in the next row and select a dosage.
The dosage may not begin with
a decimal, for example .5; it must begin with a numerical value, 0.5 for
example. Also, the character “^” may not be entered in the Dosage field. (The
associated cost is displayed to the right of the dosage.)
- CPRS fills in the Route and Schedule fields. If necessary, change
the values in Route and Schedule fields.
- Enter the duration and a conjunction (or no
conjunction for the final line).
Note:
Your site’s IRM staff may have
specified rules governing the status of inpatient medication orders when
patients are transferred from one ward or service to another. It may have also
specified the number of days an inpatient medication order remains active.
Please check with your site’s IRM staff for information about these rules.
You
should specify the duration for a medication order
- Repeat steps 12-14 until you have completed
the complex dose.
Note: You can also add or
remove a row in the complex dosage. If you add a row, CPRS places the new row
above the selected row. To add a row, click the gray area in front of the row
and click Add Row. To delete a row, click the gray area in front of the row to
be deleted and click Delete Row.
- Enter an Indication. If indications are defined, you
can choose one from the drop-down list. If none are defined or the correct
indication is not in the list, type in the appropriate indication.
- Add comments (optional).
CPRS displays the expected
date and time of the first dose. (For example, CPRS cannot show an expected
first dose for “on call” or schedules with PRN. On the complex tab, it will not
try to determine an expected first dose after a THEN because the first item
must be completed.)
- If you want to give an additional dose now,
select the Give additional dose now
check box. If you select the check box, the Give Additional Dose Now for
Complex Order warning dialog box appears, as shown below.
CPRS
displays a warning to providers who select “Give additional dose now” when
placing a complex order
When you select the Give additional dose now check box,
CPRS creates two new orders. Depending on your version of CPRS, the order
priority and dosing schedule may be set automatically or may require manual
adjustments. The pop-up messages displayed will also vary.
The dosing schedule and priority are set automatically for
each order. The first order is scheduled for immediate administration (NOW) and
is assigned the priority ASAP. The second order is given the priority ROUTINE
and will be administered following the dosing schedule that you defined. A
warning displays that is similar to the following example.
Note: If
your site does not use the priority ASAP, then an alternative priority (for
example, STAT) will display in place of ASAP.
Warning
displayed when “Give additional dose now” is selected
- Check the warning message to ensure that the orders you created are
what you expected. If the orders are acceptable, then click OK. If not, click Cancel to clear
the Give additional dose now
check box.
- Click the drop-down arrow and then select a
value for the Priority field.
When Give additional
dose now is selected, the Priority
field is automatically set to ASAP (or a site-specific alternative). If you
select a value for the Priority
field before you select the Give
additional dose now checkbox, a message notifies you that the selected
priority will be changed to the “Give additional dose now” priority settings.
CPRS
displays a notification that “Give additional dose now” overrides any
previously selected priority
- The default value of ASAP can be changed by
selecting a different value from the Priority
field before submitting the order. If the Priority field is empty when the order is submitted, it will
revert to the default values for “Give additional dose now.” Click Accept
Order.
Note: If you do not complete the mandatory items or
if the information is incorrect, CPRS sends a message telling you that the
information is incorrect and showing you the correct type of response.
- (Conditional) If the medication ordered may be contraindicated
because of allergies, drug interactions, or duplicate orders, CPRS will
display the Order Check window. Carefully review all order checks and
decide if the medication should be ordered. Do one of the following:
o
To proceed, select
Accept Order.
o
To stop the ordering
process and return to the dialog, Cancel Order.
- Enter another medication order or click
Quit.
Note: You must sign the order before CPRS sends it
to the Pharmacy package. You can either sign the order now or wait until later.
When using Give additional dose now, it is recommended that you sign the order
immediately to send the order to the inpatient pharmacy. You need only sign
once for both orders created when Give additional dose now is selected.
Ordering Inpatient Medications for Outpatients
Note: If IMO Nursing orders do not display where
expected, they may not be set up properly. IRM or CAC personnel should check
the CPRS Technical Manual: GUI Version
for more information.
Note: If the
provider has an NPI, it will not display on the screen below.
This
example shows the Orders tab with order from several services, including orders
that can appear under the IMO display group of Clinic Orders
On the Meds tab, IMO medication orders of all statuses
except unreleased orders display at the top of the Inpatient Medications pane
before other inpatient medications orders. Nursing text orders do not display
on the Meds tab. User can distinguish IMO orders because they have an entry in
the Location column of the Meds tab display.
Note: IMO
orders are affected by both CPRS auto-DC rules and Inpatient Medications rules
for auto-discontinuing orders on admission and discharge. If sites do not want
IMO orders to auto-discontinue on admission and discharge, sites will have to
ensure that neither CPRS nor Inpatient Medications discontinues IMO orders.
Inpatient Medications uses the AUTO-DC IMO ORDERS parameter to exclude IMO
orders from being discontinued.
Criteria for Ordering Inpatient Medications for
Outpatients
To successfully write inpatient-medication orders for
outpatients, the outpatients must meet at least one of the following
criteria:
o
They must have a
scheduled appointment at an authorized hospital location for the current day or
a day in the future
o
They must be currently
checked in at an authorized hospital location
Note:
If
patients do not meet either of these criteria, you can create a new visit for
them at an authorized hospital clinic. To create a new visit, select the
Provider/Encounter button,
a.
Select the Visit tab.
b.
Select New.
c.
Select OK.
In addition, before you can use the Meds tab to place IMO orders, your site’s IRM staff must set up the
new-medication order dialog to include inpatient medications.
Clozapine Requirements
See the New
Clozapine Requirements section for more information about ordering
clozapine.
Simple and Complex Doses
Take the following steps to write IMO orders:
- Select the Meds tab
- From the main menu, select Action | New Medication or click to
select the area within the Inpatient Medications window, then right click
and select New Medication from the shortcut menu. (You can also place
inpatient-medication orders for outpatients via the Orders tab. For
detailed instructions, see "Ordering Inpatient Medications for
Outpatients" in the “Orders” section of this manual.)
- CPRS prompts you to select a location for current activities.
Select a scheduled (current or future) appointment at an authorized
hospital/clinic location, or create a new visit in an authorized
hospital/clinic location using the default time for new visits (NOW).
- CPRS displays one or more new medication
dialogs. These dialogs are site—and sometimes user—specific. For example,
the person who manages information resources at your site may have set the
ORWDX NEW MEDS parameter (which controls the new-medication order dialog)
to display a list of your inpatient and outpatient quick orders.
New-medication dialogs can vary
widely. This sample dialog enables a specific user to select from a list of his
inpatient and outpatient quick orders, among other things
However, the person who manages
information resources at your site could also define a generic dialog for all
applicable users.
This new-medication order dialog
offers a variety of options that are not user-specific
- Select an inpatient medication.
Once the name is selected, CPRS
displays a second dialog to select the items for the rest of the order. In the
top field of the second dialog, the generic medication name and the synonym
(usually a brand name) are displayed.
- To place a simple-dose or complex-dose
order for this medication, follow the steps outlined in the “Simple Dose”
or “Complex Dose” sections of this manual, respectively.
On the Meds tab, CPRS displays IMO orders sorted at the top of the Inpatient Medications window with
corresponding authorized hospital/clinic locations in the Location column.
Changing Orders
Users can also change and renew inpatient medication orders
for outpatients
(IMO) if the user is ordering from an authorized IMO
location. If the patient’s location is not an authorized IMO location (even if
the patient is an inpatient), users will not be able to change or renew the IMO
orders. To change inpatient medication orders for outpatients, follow the
instructions in the “Changing Orders” section of this manual, respectively.
Outpatient Medications
Outpatient medication orders can be written as simple doses
or complex doses. Users must enter a medication name, dosage, route, and
schedule. For outpatient medications, dosage, schedule, and route can be
free-text entries, but the medication must be chosen from the list of options.
The route can be typed in, but to be accepted, it must be a valid route that is
in the MEDICATION ROUTES file #51.2.
CPRS displays unit dose routes based on the following rules:
- If a default medication route is defined in the orderable item
file, CPRS displays only the default medication route for the Unit Dose
orderable item in the medication route selection list.
- If there is no default medication route defined for the orderable
item, CPRS displays all possible medication routes for the dosage form to
the provider for selection.
- If there is only one possible medication route, it
will be used as the default.
- If a medication route name or its
abbreviation is not included in the selection list, a user may type it in.
Also, medications that are not in the formulary display in
the list with the letters “NF” after the name or synonym, which is also
displayed. CPRS checks for nonformulary dosages (e.g., the VA formulary may not
have a 2.5 MG pill, but it may have a 5.0 MG pill) and for non-formulary
orderable items (e.g., the VA may not carry a specific kind of allergy
medication).
Simple Dose
To write a new simple
dose Outpatient Medications order, use these steps:
- Select the Meds tab and select Action | New
Medication
-or-
Select the Orders tab and bring up the Outpatient dialog by clicking the
appropriate item under the Write Orders box. CPRS will display the Outpatient
Medications dialog as shown in the graphic below.
The
Outpatient Medications order dialog
Note: If no encounter information has been entered,
the Encounter Information dialog appears. Also, a preliminary order check is
done and a dialog may appear to provide you with pertinent information.
- Locate the
medication name or quick order name in the list box by typing characters
in the Medication field.
Note: CPRS now only auto-selects (highlights in
blue and places that entry in the field) a medication, dosage, route, or
schedule if the user types enough characters to uniquely identify an item in
the list. If the user does not enter enough characters to uniquely identify an
item, CPRS waits until the user manually selects an item using the mouse or the
keyboard.
- Select the quick order or medication name
using the mouse or keyboard. Once the name is selected, CPRS displays a
second dialog to select the items for the rest of the order. In the top
field of the second dialog, the generic medication name and the synonym
(usually a brand name) are displayed.
The lab results for the most recent lab test associated with
the selected medication are displayed in the Information field, if an
associated lab test was performed within the last 365 days.
Note: A CAC or ADPAC will need to set the OR CPRS
LAB DISPLAY ENABLED parameter to ON to activate the lab results display at a
site.
To view associated lab results for Quick Orders, a TIU
OBJECT must be inserted into the Quick Order. For more information, refer to
the Text Integration Utility (TIU)
Clinical Coordinator & User Manual. This functionality will work for
generalized Quick Orders only (orders assigned to Order Menus). It is not
currently implemented for personal Quick Orders.
The lab results functionality will not work properly for
multidivisional facilities or any sites that use different lab test names at
different sites, as only one lab test name can be associated with each drug. To
successfully implement this functionality, all facilities/divisions that share
a VistA system must use the same name for each monitored lab test.
Note: CPRS now
uses a look up from Pharmacy to determine whether the selected medication is a
controlled substance that requires the signature of a provider with a DEA
number. For controlled substances, CPRS displays a message —“Order for
controlled substance could not be completed. Provider does not have a current,
valid DEA# on record and is ineligible to sign the order”— as shown in the graphic below. CPRS allows orders for controlled substances
only when selected providers are able to sign the orders. You may need to exit
the dialog, change the provider selection, and then reenter the dialog. See Appendix D: Error Messages and
Troubleshooting for a full list of error messages related to controlled
substance ordering.
You
must have a DEA# to order certain medications
Note:
CPRS requires a patient have a
valid address if the selected outpatient medication is a controlled substance
that requires the signature of a provider with a DEA number. For outpatient
controlled substances, CPRS displays a message – “Controlled substance
prescriptions require a patient address. Please contact administrative support
to update patient address information.” if the patient does not have a valid
address. The contact information in the display may be customized using the
Enter/Edit Missing ZIP Code Message option in the GUI Parameters menu.
Controlled
substance prescriptions require a patient address
- Select the Dosage.
The dosage may not begin with a decimal, for example .5; it
must begin with a numerical value, 0.5 for example. Also, the character “^” may
not be entered in the Dosage field. (The associated cost is displayed to the
right of the dosage, see graphic under step 9 for an example.)
Note: CPRS now only auto-selects (highlights in
blue and places that entry in the field) a medication, dosage, route, or
schedule if the user types enough characters to uniquely identify an item in
the list. If the user does not enter enough characters to uniquely identify an
item, CPRS waits until the user manually selects an item using the mouse or the
keyboard.
Once a dosage is selected, any lab test results displayed in
the Information field are replaced by the National Standard Orderable Item
information.
The tier level represents medication copayment classes for
Outpatient Pharmacy charges that are dependent on the medication class. It is used to determine the charge rate for
copayments.
- Enter a Route by either
selecting one from the list or typing in a valid route.
- Enter a Schedule (select PRN, if desired).
Note: Outpatient orders for supply items do not
require a route.
- CPRS puts in the default days’ supply and
calculates the quantity based on the formula Days Supply x Schedule =
Quantity. If necessary, highlight and change the numbers in these fields.
Note: If you
change a number, CPRS will attempt to recalculate the other field, if
possible.
- Enter the number of refills.
- Select where the patient should pick up the medication.
- Select the Priority.
- Enter an Indication. If indications are defined, they
will display in the drop-down list for you to select or you may type in an
indication.
- You can also add a comment if desired.
- Select Accept Order.
- (Conditional) If the medication ordered may be contraindicated
because of allergies, drug interactions, or duplicate orders, CPRS will
display the Order Check window. Carefully review all order checks and
decide if the medication should be ordered. Do one of the following:
o
To proceed, select
Accept Order.
o
To stop the ordering
process and return to the dialog, Cancel Order.
If you are
finished ordering outpatient medications, select Quit.
Note: The order must be
signed before it is sent to pharmacy. You can either sign the order now or wait
until later.
Complex Dose
In a complex dose order, the user must define specific
characteristics for the order. Because the dose can affect the quantity, for
example, changing certain fields may cause the quantity field to either
recalculate or reset to zero to force the user to enter the quantity.
To write a new
Outpatient Medications order, use these steps:
- Select the Meds tab and select Action | New Medication…
-or-
select the Orders tab and bring up the Outpatient dialog by clicking the
appropriate item under the Write Orders box.
Note: If no encounter information has been entered,
the Encounter Information dialog appears. Also, a preliminary order check is
done and a dialog may appear to provide you with pertinent information.
- Locate the medication name or quick order
name in the list box by typing characters in the Medication field.
Note: CPRS now only auto-selects (highlights in
blue and places that entry in the field) a medication, dosage, route, or
schedule if the user types enough characters to uniquely identify an item in
the list. If the user does not enter enough characters to uniquely identify an
item, CPRS waits until the user manually selects an item using the mouse or the
keyboard.
- Select the quick order or medication name
using the mouse or keyboard.
Once the name is selected, CPRS displays a second dialog to
select the items for the rest of the order. In the top field of the second
dialog, the generic medication name and the synonym (usually a brand name) are
displayed.
The lab results for the most recent lab test associated with
the selected medication are displayed in the Information field, if an
associated lab test was performed within the last 365 days.
Note: A CAC or ADPAC will need to set the OR CPRS
LAB DISPLAY ENABLED parameter to ON to activate the lab results display at a
site.
To view associated lab results for Quick Orders, a TIU
OBJECT must be inserted into the
Quick Order. For more information, refer to the Text Integration Utility (TIU) Clinical
Coordinator & User Manual. This functionality will work for generalized
Quick Orders only (orders assigned to Order Menus). It is not currently
implemented for personal Quick Orders.
The lab results functionality will
not work properly for multi-divisional facilities or any sites that use
different lab test names at different sites, as only one lab test name can be
associated with each drug. To successfully implement this functionality, all
facilities/divisions that share a VistA system must use the same name for each
monitored lab test.
Note: CPRS now uses a look up from Pharmacy to determine whether the
selected medication is a controlled substance that requires the signature of a provider
with a DEA number. For controlled substances, CPRS displays a message—“Order
for controlled substance could not be completed. Provider does not have a
current, valid DEA# on record and is ineligible to sign the order” —as shown in
the graphic below. CPRS allows orders for controlled substances only when
selected providers are able to sign the orders. You may need to exit the
dialog, change the provider, and then reenter the dialog. See Appendix D: Error Messages and
Troubleshooting for a full list of error messages related to controlled
substance ordering.
You
must have a DEA# to order certain medications
Note: CPRS requires a patient have a valid
address if the selected outpatient medication is a controlled substance that
requires the signature of a provider with a DEA number. For outpatient
controlled substances, CPRS displays a message – “Controlled substance prescriptions
require a patient address. Please contact administrative support to update
patient address information.” if the patient does not have a valid address. The
contact information in the display may be customized using the Enter/Edit
Missing ZIP Code Message option in the GUI Parameters menu.
Controlled
substance prescriptions require a patient address
- Select the Complex dose tab.
Note: Once
you begin a complex order, you must remain on the Complex tab until you finish
that order. Do not attempt to start from or switch back to the Dosage tab. If
you do, all complex dosages will be erased and you will be forced to start
again.
Once a dosage is selected, any lab test results displayed in
the Information field are replaced by the National Standard Orderable Item
information.
- Select the Dosage field and select the appropriate dosage.
The dosage may not begin with a decimal, for example .5; it
must begin with a numerical value, 0.5 for example. Also, the character “^” may
not be entered in the Dosage field. (The associated cost is displayed to the
right of the dosage.)
Note: CPRS now only auto-selects (highlights in
blue and places that entry in the field) a medication, dosage, route, or
schedule if the user types enough characters to uniquely identify an item in
the list. If the user does not enter enough characters to uniquely identify an
item, CPRS waits until the user manually selects an item using the mouse or the
keyboard. The tier level represents medication copayment classes for Outpatient
Pharmacy charges that are dependent on the medication class. It is used to determine the charge rate for
copayments.
- Enter a Route by either selecting one from the list or typing in a
valid route.
Note:
Outpatient orders for supply items do
not require a route.
- Select the Schedule cell
and enter how often the medication should be taken (select PRN if
desired).
- Select the Duration cell
and enter a number and select units (days is the default) a patient should
use the specified dose.
- Add the appropriate conjunction: And, Then,
or no conjunction for the final line.
Note: The conjunction “Then” requires a duration to
be added.
- Select in the dosage field in the next row
and select a dosage.
The dosage may not begin with a decimal, for example .5; it
must begin with a numerical value, 0.5 for example. Also, the character “^” may
not be entered in the Dosage field. (The associated cost is displayed to the
right of the dosage.)
- CPRS will fill in the Route and Schedule fields. If necessary,
select and change the Route and Schedule cells.
- Enter a duration and a conjunction (no conjunction on the final
line).
- Repeat steps 5-12 until you have completed
the complex dose.
Note: You can also add or remove a row in the
complex dosage. If you add a row, the new row will be placed above the selected
row. To add a row, click the gray area in front of the row and click Add Row.
To delete a row, click the gray area in front of the row to be deleted and
click Delete Row.
- CPRS puts in the default days supply and
calculates the quantity based on the Days Supply x Schedule = Quantity. If
necessary, highlight and change the number in these fields.
Note: If you change a number, CPRS will attempt to
recalculate the other field, if possible.
- Enter the number of refills.
- Select where the patient should pick up the medication and the Priority.
- Enter an Indication. If indications are defined, they
will display in the drop-down list for you to select or you may type in an
indication.
- You can also add a comment if desired.
Under certain circumstances, a check box may appear under
the Days Supply field. If the medication is service-connected, make sure the
box is checked.
- Select Accept Order.
- (Conditional) If the medication ordered may be contraindicated
because of allergies, drug interactions, or duplicate orders, CPRS will
display the Order Check window. Carefully review all order checks and
decide if the medication should be ordered. Do one of the following:
o
To proceed, select
Accept Order.
o
To stop the ordering
process and return to the dialog, Cancel Order.
- If you are finished ordering outpatient
medications, select Quit.
Note: The order must be signed before it is sent to
pharmacy. You can either sign the order now or wait until later.
Documenting Non-VA Medications
The Joint Commission on Accreditation
of Healthcare Organizations (JCAHO) has indicated that all medications,
including herbal supplements, over-the-counter (OTC) non-prescription
medications, and medications prescribed by providers outside the VA (collectively
known as “Non-VA medications”) should be documented in the medical record.
CPRS, Outpatient Pharmacy, and Inpatient Medications developers have made
changes that enable users to enter this information into the medical record so
that providers have a better picture of the medications the patient is taking
and that order checks against these medications can occur.
Documenting Non-VA Medications will trigger the following
order checks:
o
Duplicate Drug (shows
as Duplicate Order check)
o
Duplicate Drug Class
o
Critical Drug
Interaction
o
Significant Drug
Interaction
o
Allergy checks
Note: For Non-VA
medications, inpatient orders are not checked against documented non-VA medications
and the allergy check is slightly different. The duplicate drug class check
will not be triggered for two pure herbal medications, such as ginger and
gingko. All pure herbal medications belong to the same drug class (HA000). If
these checks were made, every time a clinician entered a pure herbal
medication, the user would receive a duplicate drug class warning. Allergy
checks will still occur for non-VA medications that do not belong to this drug
class.
Making Non-VA Meds Available to Document
For users to be able to document these medications through
CPRS, they must be in the CPRS Orderable Items file so that they appear when
the user chooses Non-VA Medications (Documentation) from the Write Orders pane.
The Pharmacy patch (PSS*1.0*68) enables sites to mark items as Non-VA
Medications. Initially, all Pharmacy orderable items that are marked as
“outpatient” and are not supply items will be automatically made Non-VA
medications also. Subsequently, Pharmacy coordinators can use the Pharmacy option
Drug Enter/Edit [PSS DRUG ENTER/EDIT] to identify items as Non-VA Meds or
remove the designation.
Note: For more
information about how to get Non-VA Medications added to the appropriate file,
please see “Section 5.1: Communicating New Non-VA Meds Entries to the
Pharmacist” in the Herbal/OTC/Non-VA Meds
Documentation Release Notes that will be located on the VistA Documentation
Library at http://www.va.gov/vdl
under the Outpatient Pharmacy listings.
Different from Ordering Medications
Remember that documenting Non-VA Medications is not the same
as placing orders. Users simply enter information to provide a more complete
view of what the patient is taking. However, once the items are available in
the CPRS Orderable Items file, the process for documenting Non-VA Medications
is similar to entering other orders, but there are a few differences:
o
Almost any CPRS user
can document the Non-VA medication information. However, sites can restrict
access for those holding the OREMAS key by using the OR OREMAS NON-VA MEDS
parameter. For more information about this parameter, please see the CPRS Technical Manual: GUI Version.
o
Electronic signature
is not required for Non-VA Medication (Documentation) items.
o
Users can document a
Non-VA medication even if they only have partial information. The only required
information is the non-VA or herbal medication name. The Medication name must
be one that can be selected from the list. The Dosage, Route, and Schedule fields
are optional and will accept free-text entries.
o
Non-VA medications are
listed separately on the orders tab and the designation Non-VA Meds
(Documentation) is displayed at the beginning of the entry in the Service
column of the grid.
o
Users may pick a
reason why the patient is taking the Non-VA medication.
For the reason/statement that users
should enter, developers sent out four reasons or statements at the package
level of the parameter GUI Non-VA Med Statements/Reasons that were agreed upon
by a workgroup:
o
Non-VA medication not
recommended by VA provider.
o
Non-VA medication
recommended by VA provider.
o
Patient wants to buy
from Non-VA pharmacy.
o
Medication prescribed
by Non-VA provider.
Authorized users can enter their own reasons/statements in
the parameter by entering new statements at the System or Division level for
this parameter. For more information about changing this parameter, see the CPRS Technical Manual: List Manager.
Documenting Non-VA Medication
Information for Simple Doses
Previously, the designation “Non-VA Meds” caused some
confusion as to whether providers were ordering or documenting outside
medication. Therefore, throughout CPRS the name has been changed to “Non-VA
Medications (Documentation)” on the Write Orders pane or “Non-VA Meds
(Documentation)” in the Service column. When the user selects the Non-VA
Medications (Documentation) option, the dialog displays the items that were
marked as Non-VA Meds and copied into the CPRS Orderable Items file.
As
shown on the Orders tab, the Non-VA Meds (Documentation) orders display.
To document Non-VA medication information for a simple dose,
use the following steps:
- If you are not already there, go to the Orders tab by either
clicking Orders or pressing Ctrl + O.
- In the Write Orders list, select Non-VA Medications (Documentation).
Note:
If encounter information has not
been entered, the encounter information dialog will appear before the
Medication Order dialog. You must complete the encounter information dialog
before proceeding.
- In the Document Herbal/OTC/Non-VA Medications dialog, select the
medication or herbal supplement by
a.
Typing a few letters
of name.
Note: CPRS now only
auto-selects (highlights in blue and places that entry in the field) a
medication, dosage, route, or schedule if the user types enough characters to
uniquely identify an item in the list. If the user does not enter enough
characters to uniquely identify an item, CPRS waits until the user manually
selects an item using the mouse or the keyboard.
b.
Selecting the correct
name or synonym (often a brand name) from the list by double-clicking it or
highlighting it and pressing <Enter>. You may need to scroll down to find
the name.
Note: If you do not know
other information such as dosage, route, or schedule, you may enter only the
name of the medication or herbal supplement.
- Enter a dosage (if known).
The dosage may not begin with a
decimal, for example .5; it must begin with a numerical value, 0.5 for example.
(The associated cost is displayed to the right of the dosage.)
- Enter a route (if known).
- Enter a schedule, including PRN if necessary (if known).
- (Not required) Enter an Indication. If indications are
defined, they will display in the drop-down list for you to select or you
may type in an indication.
- Enter any comments.
- If you want to enter one, select one or more
Statements/Explanations as to why the patient is taking the medication or
supplement (optional).
- Enter a start date (if known).
- Review the information entered in the text box at the bottom of the
dialog.
- Place the information into the patient’s record by clicking Accept
Order or by tabbing to Accept Order and pressing <Enter>.
- (Conditional) If the medication ordered may be contraindicated
because of allergies, drug interactions, or duplicate orders, CPRS will
display the Order Check window. Carefully review all order checks and
decide if the medication should be ordered. Do one of the following:
o
To proceed, select
Accept Order.
o
To stop the ordering
process and return to the dialog, Cancel Order.
- To document additional Non-VA Medications into the patient’s
record, repeat steps 3-12.
- When you are through documenting Non-VA
medications, exit the dialog using the Quit button.
Note: Non-VA Meds do not
require an electronic signature, but they will be presented at the end of the
current CPRS session on the Sign screen. You can do the normal signing process
or if you only have Non-VA meds, you might get OK and Cancel buttons on a dialog
instead of the normal Sign screen. You cannot click on the checkbox in front of
a Non-VA Med to deselect and not approve it. Non-VA Meds because they do not
require electronic signature will be automatically entered when you click OK or
enter your electronic signature.
Documenting
Non-VA Medication Information for Complex Doses
When you start documenting non-VA medication information for
a complex dose, you need to remain on the Complex tab until you click the
Accept Order button. If you switch to
the Dosage tab, all complex dosages will be erased.
To document Non-VA medication information for a complex
dose, use the following steps:
- Click on the Meds tab and then, click on the Action menu in the
toolbar.
- Select Document Non-VA Meds from the Action
menu.
Note: If encounter
information has not been entered, the encounter information dialog will appear.
You must complete the encounter information dialog before proceeding.
- In the Document Herbal/OTC/Non-VA Medications dialog, select the
medication or herbal supplement from the dropdown. If you enter a few characters in the
Name field, you will immediately see a list of names in the dropdown that
contain those characters.
- Select the Complex tab.
- Enter the appropriate dosage in the Dosage
field.
Note: The dosage must begin with a numerical value (for example,
0.5). The dosage cannot begin with a
decimal (for example, .5) and the ^
character is not allowed.
- Enter
a Route by either selecting a value from the dropdown or entering a value.
- Select
a value from the Schedule dropdown. Check the PRN checkbox, if necessary.
- In
the Duration field, enter a numeric value and select the units a patient
should use for the specified dose (day is the default).
- In the add/then dropdown, select a
direction and a conjunction (no conjunction on the final line).
Note: If you select the “then” conjunction, you are required to add
a duration.
- In the next row, enter a dosage in the Dosage field.
- If necessary, change the values in the Route and Schedule fields.
- In the add/then dropdown, enter a duration and a conjunction (no
conjunction on the final line).
- Repeat steps 5 through 12 until you have
completed the complex dose.
Note: To add a row, click on
the area where you want to place the new row and then, click on the Insert Row
button. To remove a row, click on the row to be deleted and then, click on the
Remove Row button.
- Enter an Indication (optional). If indications are defined, they
will display in the drop-down list or you may type in an indication.
- Add a comment (optional).
- Select one or more Statements/Explanations as to why the patient is
taking the medication or supplement (optional).
- Enter a Start Date, if known.
A Start Date can be a date in the past.
- Review the information entered in the textbook at the end of the
dialog.
- Click the Accept Order
button.
- (Conditional) If the non-VA medication may be contraindicated
because of allergies, drug interactions, or duplicate orders, CPRS will display
the Order Check window. Carefully review all order checks and either click
the Accept Order button or the Cancel Order button.
- When you finish documenting non-VA
medications, click the Quit
button.
Note: Non-VA
Meds do not require an electronic signature.
At the end of the current CPRS session, you will see the Review/Sign
Changes window and will be able to click on the OK or Cancel button
without signing the order. After you
click the OK button, you may see the
Order Checks screen if there is a potential conflict between a non-VA med and
an existing inpatient or outpatient order.
Release Hold
This action enables a user to release the hold that someone
has placed on a medication order.
To release the hold on a medication, use these steps:
- Select the Meds tab.
- Locate and highlight the medication that you want to release from
being held.
- Select Action | Release Hold…
Note: If the order has
expired, you should see a message that says, “Cannot be released from Hold.
Reason: This Order has Expired.”
Hold Orders
Only active orders may be placed on hold. Orders placed on
hold will continue to show under the ACTIVE heading on the profiles until it is
removed from hold. An entry is placed in the order’s Activity Log recording the
person who placed/removed the order from hold and when the action was taken.
To place a medication on hold, use these steps:
- Select the Meds tab.
- Locate and highlight the medication.
- Select Action | Hold.
Park a Prescription
This action enables a user to select “park” as a
routing/pickup option when creating or modifying an outpatient pharmacy
order. When a prescription is parked, it
is on file, but it will not be dispensed until requested by the patient or
caregiver. A parked prescription has an
Active/Parked status in reports and cannot be sent to automated dispensing
equipment or to CMOP until it is unparked. Park a prescription works with mail-in
barcode refills requests and the AudioCare AudioRefill System.
Note: Park a
prescription only works with outpatient pharmacy orders.
Any activity performed for an active prescription can be
performed for an active/parked prescription.
CPRS allows the initial fill, and the refill of a prescription in
Active/Parked status.
Only active prescriptions can be parked. Drugs with a DEA special handling code of “D”
and Clozapine orders cannot be parked.
When a patient requests a fill of a prescription that has
been replaced by a newer, parked prescription for the same orderable item but
different dispense drug, the fill will get processed as if the newer
prescription was requested. However, the
old prescription number will be used. This “linking and replacement” capability
is limited by specific conditions:
● The patient requesting the prescription must be the same
for both the previous and parked prescription.
● The prescriptions must be for the same orderable item.
● The previous prescription for the orderable item is no
longer active.
● The most recent prescription is in Active/Parked status.
● There is only one prescription on file for the specific
patient and orderable item.
If these conditions are not met, the
user will see this error message: “[Rx
number] is no longer refillable please speak to a pharmacist”.
Once a prescription is unparked, it will proceed through
normal prescription processes.
To park a new prescription, do the following:
- Click on either the Meds or Orders tab:
- If you clicked on the Meds tab, click on Action and then, click on New Medication.
- If you clicked on the Orders tab, click on Outpatient Meds in the Write
Orders table.
- On the Location for Current Activities screen, select a Visit
Location and Date/Time of Visit and click OK.
- On the Outpatient Medications or Medications Orders screen, fill in
all required fields: Medication, Dosage, Route, Schedule, Indication, Days
Supply, Quantity, Refills and Priority. In the Pick Up area, select the Park radio button.
- Click Accept
Order. After the order has been accepted, it will be in the Pending
status until the pharmacist processes the order, at which point it will
become Active/Parked.
To park an existing prescription, do the following:
- Click on either the Orders or Meds tab.
- Right-click on an active outpatient medications order and then,
click on Park.
- On the Park Orders screen (the confirmation
screen), click OK. The order
will get into the Active/Parked status.
To unpark a prescription, do the following:
- Click on either the Orders or Meds tab.
- Right-click on an Active/Parked outpatient order and then, click on
Unpark – Generates a request to
Fill/Refill.
- On the Un-Park Orders screen (the
confirmation screen), click OK. An unparked order will go into an
Active/Suspense status.
Renewing Orders
Active orders may be renewed. In addition, inpatient
medication orders that have expired in the last four days and outpatient
medication orders that have expired in the last 120 days may be renewed.
Note: If the original order
had comments, the comments do not carry over when the user renews an order.
This is to prevent comments that should only apply to the original order from
mistakenly being carried forward with the renewed order.
The default Start Date/Time for a renewal order is
determined as follows:
Default Start Date Calculation = NOW
The default start date/time for the renewal order will be
the order’s Login Date/time. Default Start Date Calculation = USE NEXT ADMIN
TIME
The original order’s Start Date/Time, the new order’s Login
Date/Time, Schedule, and Administration Times are used to find the next
date/time the order is to be administered after the new order’s Login
Date/Time. If the schedule contains “PRN” any administration times for the
order are ignored.
Default Start Date Calculation = USE CLOSEST ADMIN TIME
The original order’s Start Date/Time,
the new order’s Login Date/Time, Schedule, and Administration Times are used to
find the closest date/time the order is to be administered after the new
order’s Login Date/Time. If the schedule contains “PRN” any administration
times for the order are ignored.
After the new (renewal) order is accepted, the Start
Date/Time for the new order becomes the Stop Date/Time for the original
(renewed) order. The original order’s status is changed to RENEWED. The renewal
and renewed orders are linked and may be viewed using the History Log function.
Once an order has been renewed it may not be renewed again or edited.
CPRS lets you edit the days’ supply,
quantity, number of refills and pick-up method for an active outpatient
medication during the renewal process.
However, it does not let you edit those fields for any other type of
order being renewed.
To edit the days’ supply, quantity, number of refills and/or
pickup method for an outpatient medication, do the following:
- Click on either the Orders or Meds tab.
- In the Outpatient Medications or Out Meds table, right-click on an
order in the Active, Active-Susp or Active-Parked status.
- Click Renew on the
dropdown menu. If a visit location hasn’t been selected, the Location for
Current Activities screen will appear, and you will need to select a Visit
Location and Date/Time of Visit.
- On the Renew Orders screen, click the order to be renewed and then,
click the Change Days Supply/Quantity/Refills/Pick Up button.
- On the Change Refills for Outpatient Medication screen, update the
Days Supply, Qty, Refills and/or Pick-Up values and click OK.
Note: If you edit the Days Supply, the system
will attempt to update the quantity based on the formula, Days Supply x
Schedule = Quantity.
- On the Renew Orders screen, click OK.
Example of the Renew Orders and Change Refills for Outpatient Medication
screens
Discontinuing Orders
When an order is discontinued, the order’s Stop Date/Time is
changed to the date/time the action is taken. An entry is placed in the order’s
Activity Log recording who discontinued the order and when the action was
taken. Pending and Non-verified orders are deleted when discontinued and will
no longer appear on the patient’s profile.
For unsigned, unreleased orders, if the user discontinues
the order in the same CPRS session when the order was placed, the order is
deleted and will not display. The reason for this is that the order was never
seen by anyone else, therefore, it can be deleted. If the order is unsigned and
unreleased, but was placed in a different CPRS session, another user may have
seen the order, therefore, the order is CANCELLED, but still displays so that
others who might have seen it know that it was cancelled.
To discontinue an order, use these steps:
- Select the Orders tab.
- Select the order or orders you want to discontinue.
- Select Action | Discontinue/Cancel.
A dialog may appear asking for the
clinician’s name and the location (encounter information).
- Select the name of the clinician (you may
need to scroll through the list), select the encounter location, and then
select OK.
Another dialog will appear asking
for the reason why the order is being discontinued.
- Select the appropriate reason from the box in the lower left of the
dialog and select OK.
- If the order you are discontinuing is a pending
renewal of another order, CPRS needs to know how to deal with the order
you are discontinuing, and the original order. Choose the appropriate
action from the dialog that displays:
● DC Both
● DC Pending
● Cancel – No Action Taken
Changing Orders
To change an order:
- Select the Orders tab.
- Select the order to highlight it.
- Select Action | Change... or right-click
the order and click Change....
Note: If the provider or location has not been defined, you will be
prompted for that information.
- Complete the changes as appropriate in the
dialog box that appears on the screen.
Note: The original order’s comments are not brought forward on a
change to prevent inadvertently using a comment that was only for the original
order.
- Select Accept.
Note: You may sign the order now or later.
Viewing a Medication Order
When you select the Meds tab, you see a list of medications
that have been ordered for this patient. You can get a more detailed display of
each order by double clicking the order.
Note: You can also review or add medication orders from the Orders
tab.
When ordering medications, you can order Outpatient Pharmacy
or Inpatient Meds, which includes IV Fluids and Unit Dose.
Transfer Outpatient Meds Order to Inpatient
You can transfer outpatient medications to inpatient
medications with CPRS. CPRS will tell you if the medication cannot be changed
to an inpatient medication.
Because of the differences, you will go through each order
and make the necessary changes.
To transfer the medication to inpatient, use these steps:
- Click the Meds tab.
- Select the outpatient medications you want to transfer. Hold down
the CTRL key to select more than one medication. Hold down the Shift key
and click the first and last medications to select a range.
- Select Action | Transfer to Inpatient.
- Enter the necessary information for the
first order and click Accept.
Note: Provider comments are
brought forward for editing if necessary. Sometimes, provider comments give
needed instructions to the patient.
- Repeat step 4 as needed for the selected
medications.
Note: When finished, you
can sign the orders now or wait until later.
Transfer Inpatient Meds Order to Outpatient
You can transfer inpatient medications to outpatient
medications with CPRS. CPRS will tell you if the medication cannot be changed
to an outpatient medication.
Because of the differences, you will go through each order
and make the necessary changes.
To transfer the medication to outpatient, use these steps:
- Select the Meds tab.
- Select the inpatient medications you want to transfer. Hold down
the CTRL key to select more than one medication. Hold down the Shift key
and click the first and last medications to select a range.
- Select Action | Transfer to Outpatient.
CPRS
displays the Copy Medication Orders dialog.
The Copy Medication Orders dialog
- If you would like to release the copied order(s) immediately, check
the “Released copied orders immediately” option. If you would like to
delay the release of the copied order(s), select one of the options in the
“Delay release of copied orders until” group.
- Select OK.
The Medication Order dialog
displays.
- Enter the necessary information in the Medication Order dialog for
the first order and select Accept.
- Repeat Step 6 as needed for the selected
medications. Note: When
finished, you can sign the orders now or wait until later.
Refilling a Medication
Users can order a refill of outpatient medications if:
•
The medication is an
outpatient medication.
•
The provider
originally wrote the order with refills and there are refills remaining.
•
The expiration date is
in the past.
To order an
outpatient medication refill, use these steps:
- Go to the Meds tab.
- Select the medications you wish to refill that meet the above
criteria.
- Select Action | Refill… or right-click on
the orders and select Refill… from the popup.
The following dialog displays. Note: The Refill Orders dialog in CPRS does not allow you to choose
Park. A pharmacist would need to update
the prescription to Parked when they get the refill request.
In the Refill Orders dialog, CPRS
displays the medications the user selected to refill and enables the user to
choose the pickup method
- In the Refill Orders dialog, choose the Pick Up method (at Window
or by Mail).
- Select OK.
Using the Unified Action Profile View
The Unified Action Profile (UAP) view on the Orders tab
displays existing inpatient and outpatient medication orders from the local
site on a single page. Using this view, a clinician can record decisions for
all orders assigned to a patient to ensure that the correct medication orders
are continued for the patient upon discharge.
Previously, when preparations were made to discharge a
patient, the clinician had to switch views from inpatient to outpatient
medication forms. The UAP enables the clinician to review all medication orders
at one time. This view simplifies order reconciliation and reduces the time and
effort required from the clinician when making decisions on each active
inpatient and outpatient order.
Understanding UAP Sorting
The UAP view sorts medication orders by medication name,
with inpatient, outpatient, and non-VA medication orders grouped together. This
grouping is essential for medication reconciliation when preparing a patient
for discharge. UAP sorting is based on the name of the first orderable item
from the Orderable Items file (#101.43). However, subsequent changes to the
order can disrupt this rule and alter the way that the order is sorted by UAP.
The Order Text field (#100.0081) in
the Order file (#100) is a word processing field that is generated when an
order is created. Additional Order Text fields are added each time the order is
modified. When working with an order in CPRS, the content of the most recent
Order Text field is displayed. UAP checks the first line of the Order Text
field against the orderable item name. If this check detects that the first
line of the Order Text field does not match the orderable item name, then the
order is sorted based on the first line of the most recent Order Text field.
For example, a clinician places an order for “DIAPER TABBED
MISCELLANEOUS BRIEF, TRANQUILITY SMARTCORE SMALL #2311.”
This item is retrieved from the Orderable Items file and
saved in the Order Text field when the order is placed. During processing, the
Pharmacist changes the order
to “BRIEF, TRANQUILITY SMARTCORE SMALL #2311” and this
update is
saved as a new entry in the Order Text field. During
sorting, UAP performs a check and detects that the Orderable Item name and the
first line of the most recent entry in the Order Text field are not the same
and sorts the item based on the Order Text field entry (i.e., “BRIEF,
TRANQUILITY SMARTCORE SMALL #2311”). If an order is modified by a pharmacist
during prescription processing, then the order is marked with an asterisk (“*”)
when displayed in CPRS. In the UAP view, this asterisk is hidden when displaying
orders to preserve the alphabetical sorting critical to the reconciliation
process.
Infusions are sorted alphabetically by the first orderable
item identified as an additive in the Orderable Items file; solutions are
ignored for the purpose of sorting. The display of Infusion orderable items is
reorganized based on the additive used for sorting. This supports alphabetical
sorting by a meaningful additive in the UAP but does not change the original
order of items in the ORDER file (#100).
Configuring UAP
Before UAP can work as designed, some setup is required.
First, Write Delayed Orders must be configured for the DISCHARGE event.
Note: To
perform the following actions, the DISCHARGE event must be active and Copy
Active Orders for Discharge Release Events must be disabled.
Refer to the CPRS Technical Manual: GUI Version for details.
To configure the Write Delayed Orders feature for the
Discharge event:
- From the CPRS Orders tab, click Write Delayed Orders. The Release
Orders window displays.
- Select the Delay release of new order(s) until radio button.
- Select DISCHARGE from the Event Delay List.
- Adjust the Effective
Date if necessary and then click OK.
Write Delayed Orders button displays
the Release Orders window
Note: If the provider has an NPI, it will not display on the screen
above.
The view changes to the Delayed
DISCHARGE Orders view. The Discharge Patient (Delayed DISCHARGE) dialog box
displays with DISCHARGE as the selected event.
Discharge Patient (Delayed
DISCHARGE) dialog box
Note: If the provider has an NPI, it will not display on the screen
above.
- Select a Discharge
Type (e.g., REGULAR) and then click Accept Order.
The Delayed Discharge order
displays on the Orders tab. The Service column displays the service “A/D/T”
after the order is configured. The Delayed Discharge order remains unsigned
until after the UAP review decisions are completed and all medication orders
for the patient are ready to be signed.
Unsigned Delayed Discharge
Order
Note: To perform the following actions, the UAP view
must be turned On by a CAC or OI&T staff member. If UAP is not displayed in
the View menu, then the feature is turned Off. Refer to the CPRS Technical Manual: GUI Version for
details.
To use the UAP view to reconcile all inpatient and
outpatient medications when preparing a patient for discharge:
- Select United Action Profile (UAP) from the
View menu.
Unified Action Profile (UAP) option
displays on the View menu
The Unified
Action Profile view is displayed and ready for you to take action on each
inpatient and outpatient medication.
Unified Action Profile on the CPRS
Orders tab
Note: If the provider has an NPI, it will not display on the screen
above.
Example: Infusion Orders – ALL SERVICES view vs. UAP view
The following Infusion order is
displayed in the ALL SERVICES view. The asterisk indicates that the order was
changed by the pharmacist.
The ALL SERVICES view displaying the
Infusion order with the asterisk and list of orderable items
In the UAP view, the Infusion order
components are intentionally reorganized for sorting purposes to facilitate
medication reconciliation. The asterisk is hidden; the first orderable additive
item in the ORDER file, INSULIN, is listed first and the Infusion is displayed
in the medication list accordingly. The solution (DEXTROSE) is ignored for
sorting purposes.
UAP displaying the Infusion order
without asterisk and sorted by first orderable additive item
- Right click on a medication order and then
select an available reconciliation action from the popup list.
List of reconciliation actions
displayed in the UAP view
Note: Infusion orders
cannot be continued, changed, or renewed using UAP because CPRS does not
convert inpatient infusion orders to an outpatient order when preparing for
discharge. To prevent issues with discharge medication orders, these options
are grayed when performing UAP medication reconciliation for an inpatient
Infusion order.
- Complete required information in the
secondary window that displays when a reconciliation action is selected.
Not all selected actions will display a secondary window.
Selecting certain actions, such as Change, will open the Copy Orders
window. When this window displays, the Delay
release of copied orders radio button is selected by default. Select DISCHARGE from the list of suggested
events, and then click OK.
Copy Orders window
When DISCHARGE is selected, the
view automatically reverts to
Delayed Discharge Orders.
Additional secondary windows, such as Outpatient Medications, open for
configuring the Delayed Discharge medication order.
The decision made for each
inpatient and outpatient medication is displayed in the UAP “Reviewed” column.
Information regarding whether an order was reviewed using the UAP, and who last
reviewed it, is added to the order record in the Orders file (#100) in VistA.
Note: When a reconciliation action is canceled
before it is complete (for example, if you click Cancel in the Copy Orders
window), then no decision is recorded for the selected medication. The action
is briefly displayed in the UAP “Reviewed” column, but after processing the
display toggles back to the UAP view, the UAP “Reviewed” column is cleared, and
no decision is recorded in VistA.
The UAP Reviewed column shows the
decision made for a medication
Note: If the provider has an NPI, it will not display on the screen
above.
After
completing the UAP review, use the Discharge Meds view to see a complete list
of outpatient medications prescribed for the patient at the time of discharge
(refer to Using the Discharge Meds View on page 290).
Using the Discharge Meds View
The Discharge Meds view on the Orders tab displays a list of
the remaining active outpatient orders after medication decisions are recorded
in the Unified Action
Profile (UAP) view (refer to Using the Unified Action Profile View.). It displays the
orders that will be released with the patient upon discharge.
While the UAP provides the ability to review and make
decisions about all inpatient and outpatient medications, the Discharge Meds
view enables a clinician to see the full list of medication orders from the
local site still prescribed for the patient after the UAP review is completed.
To use the Discharge Meds view of all
prescribed medications for a patient being discharged:
- Select Discharge Meds from the View menu on
the Orders tab.
Discharge Meds option displays on
the View menu
The Discharge
Meds Review is displayed.
Discharge Meds Review on the CPRS
Orders tab
- Review the information for each medication
displayed on the Discharge Meds Review pane. Verify the dosage, quantity,
Start/Stop date, and Status for each outpatient medication prescribed for
the patient being discharged.
From the Orders tab, you can write new orders and view
existing orders for the selected patient. You can also create quick orders and
order sets that make the ordering process more efficient. The Orders tab also
allows you to quickly access information about each order such as which
services the orders are associated with, the start and stop dates for each
order, the name of the provider (or nurse or clerk) that entered the order, and
the status of the order.
Note: If the
provider has an NPI, it will not display on the screen below.
The
Orders tab
Viewing Orders on the Orders Tab
You can control which orders appear on the Orders tab by
defining specific criteria. For example, you can specify that only unsigned
orders associated with a specific service or section appear on the Orders tab.
Unsigned orders are underlined on the Orders tab. Unsigned
orders for the current provider are bold and underlined.
Predefined views or sorting on the Orders tab include the
following options:
•
Active Orders (including pending, recent activity) – This view includes orders that have a status of
o
Hold
o
Flagged
o
Pending
o
Active
o
Scheduled
o Partial Results
o
Unreleased
o
Renewed
o Parked
Recent activity also includes the
following if their status changed in the number of hours you site defines in a
system parameter:
o
Discontinued
o
Complete
o
Expired
o
Cancelled
•
Current Orders (active/pending status only) – This name of this view explains it, active and pending
orders only.
•
Auto DC/Release Event Orders – This view includes only those orders that will be
automatically discontinued or automatically released when an event occurs.
•
Expiring Orders – This
view shows all orders that will expire between now and midnight or now and
midnight of the following day if the following day is a holiday.
•
Unsigned Orders – This
view shows orders that have not been signed.
•
Recently Expired Orders –
This view shows orders that have expired within the number of hours specified
by a system parameter.
Locating IV Orders on the Orders Tab
In which display group CPRS places the IV medication orders
depends on how the pharmacist finishes it. After CPRS v. 27, IV orders entered
through the Infusion dialog should display under the Infusion display group,
while those entered through the Unit Dose dialog should display under the
Inpatient display group (Inpt. Meds). However, the key is how the pharmacist
finishes the order. If the pharmacist finishes the order as a Unit Dose
medication, it will display under the Inpatient display group. If finished as
an IV order, then CPRS displays the order under the Infusion display group.
Changing the View on the Orders Tab
To create a specific view of the orders, users have the
Custom Order View menu option. When the user selects Custom Order View, the
dialog should display with the settings of the current view.
To view orders on the Orders tab, follow these steps:
- Select the Orders tab.
- Select View | Active Orders (includes
pending, recent activity), View | Current Orders (active/pending status
only), View | Auto DC/Release Event Orders, View | Expiring Orders, View |
Unsigned Orders, or View | Recently Expired Orders.
-or-
Select the type of order you want
to view from the View Orders pane on
the left side of the Orders tab.
Note:
If you select View | Auto
DC/Release Event Orders the Auto
DC/Release Event Orders dialog box appears, select the release event
associated with the orders you would like to view and click OK.
If
you select View | Recently Expired Orders, the parameter ORWOR EXPIRED ORDERS
stores the number of hours in the past that CPRS will look for expired orders.
A coordinator can set this value for your site.
The
appropriate orders will appear on the Orders tab.
If you would like to filter the
orders further, continue with step 3.
- Select View | Custom Order View…
The Custom Order View dialog box appears. The settings in the dialog
should match what is currently displayed on the Orders tab.
The Custom Order View dialog. To
view Inpatient Medication for Outpatient orders, users can expand the All
Services service/section and then select Clinic Orders or they can expand All
Services, expand Pharmacy, and then select Clinic Orders
- Select the criteria for the orders that you want to display on the
Orders tab by taking some or all of the following steps:
o
Select an order status
from the left pane. (Click + to
expand a heading.)
o
Select a service or
section from the right pane. (Click +
sign to expand a heading.)
o
If you want to limit
the orders to a specific date range, select the Only List Orders Placed During Time Period checkbox and enter a
from and through date. Click to choose a date from a calendar.
o
Click Reverse Chronological Sequence if you
want the oldest orders to appear at the top of the Orders tab.
o
Click Group Orders by Service if you want the
orders to be sorted according to the service they are associated with.
- Select OK.
The orders that meet the criteria
you specified on the Custom Order View dialog will appear on the Orders tab.
The criteria for the displayed orders will appear above the Service column.
Note: If all of the active orders are not displayed on the Orders
tab, the 
icon appears below the Postings button (on the right side of the screen).
Note: If the provider has an NPI, it will not display on the screen
below.
Note: The Custom Order View status
selection screen modified an existing option and added a new option:
- Unverified Inpatient by
anyone previously named "Unverified by Anyone"
- Unverified Outpatient by anyone
When any
option, under and including “Unverified Outpatient by anyone,” is selected, it
will include outpatient orders (except outpatient medications and Non-VA
medications), so these patient orders are not missed. Clinic medication and
infusion orders will be included in results for inpatient and outpatient views.
When showing search results, the
top of the Orders tab view will display the search criteria that was selected.
The Orders tab can be customized to
display specific orders
Using the right-click menu on the
Orders tab, if the user selects several items and the right-clicks either on
the items or elsewhere in the list, CPRS displays a popup menu. When the user
selects an action from the popup menu, the action applies to all selected
items. For example, if the user selects three orders and selects Discontinue,
the dialog appears with those three orders listed for discontinuation.
However, if no items are selected
(highlighted in blue) and the user right-clicks on an item, it is selected and
the popup menu appears.
The Orders tab popup menu includes
the following items:
o
Details…
o
Results
o
Results History…
o Change…
o
Change Release Event
o
Copy to New Order…
o
Discontinue…
o
Refill…
o
Renew…
o
Sign…
Viewing Results
To view the results of an order, follow these steps:
- Select the Orders tab.
- Highlight the appropriate order.
- Select View | Results.
The results of the order will be displayed.
Note: You can also right-click on the appropriate
order and select Results… from the
right-click menu.
To view a history of results, follow these steps:
- Select the Orders tab.
- Highlight the appropriate order.
- Select View | Results History… The results
history will be displayed.
Note: You can also
right-click on the appropriate order and select Results History… from the
right-click menu.
To set a default view for the Orders tab, follow these
steps:
- Customize the Orders tab by following the steps above.
- Select View | Save as Default View.
The Save Default Order View dialog box appears.
- Select OK.
The current view will be set as the
default view for the Orders tab.
Writing Orders
Orders are placed from the Write Orders pane on the Orders
tab. You can place orders for a variety of items and procedures including
medications, consults, and lab tests. You can also enter information about a
patient’s allergies. Order checks are performed on all orders.
Users can specify that an order become active immediately,
or specify that an order be event-delayed and activated only after a specific
event occurs, such as when a patient is admitted, transferred, or discharged.
You can also save common or standard orders as quick orders or order sets so
that they can be placed more quickly.
Note: The orders
listed in the Write Orders pane vary from site to site. Because of this, the
orders discussed in this section may not be available from your Write Orders
pane.
Note: The View
Orders Pane may display additional options for views, including the Unified
Action Profile and Active Orders views.
Note: If the provider has an NPI, it will not display on the screen
below.
You
can place an order by selecting the type of the order from the write orders
pane, selecting the appropriate category from the order menu, if CPRS displays
one, and then using the order dialog that appears
Order Checks
Order Checking is based on a system of rules that reviews
orders to see if they meet defined criteria. If they meet the criteria, an
electronic message is sent to the ordering provider to alert the provider to a
potential problem (such as creatinine clearance, polypharmacy, duplicate order,
drug-lab interaction, etc.). The provider can then choose to cancel the order
or override the order check and place the order.
The Order Checking system gives users and clinical
application coordinators (CACs) some flexibility to determine which order
checks and notifications are sent and whether the provider must enter a reason
to override the order check. To accomplish this, CPRS includes several
prepackaged order checks as well as three menus for setting Order Checking
parameters such as enabling and disabling specific order checks. Order Checks
can also be configured to be mandatory by the Clinical Coordinator or IRM. If
this feature is enabled, users cannot indicate that they do not want to receive
individual order checks. Non-mandatory order checks can be enabled or disabled
through the Tools | Options menu.
CPRS calls for order checks on all orders. CPRS calls for
order checks at the following times:
▪ When the user opens the order dialog by selecting an item
from the Write Orders pane or from an order menu. For medication orders, CPRS does allergy
checking only at the moment when the user selects the orderable item.
▪
In the order dialog
when the user selects Accept Order. Note:
Allergy checking has been removed from Accept Order and moved to Orderable
Items selection.
▪ When the user selects a sign action—before the user signs
the order
CPRS uses three kinds of order checks: site-defined Clinical
Reminder order checks, nationally released local orders checks, and remote
orders checks between sites.
Site-Defined Clinical Reminder Order Checks
CPRS enables sites to create their own order checks based on
the Clinical Reminders features. Sites will define a group of orderable items
for which certain rules apply. If the rules apply to the situation, the site
can define text that will display in the order check window. Sites can also set
the order check to require an override.
Setting Up Clinical Reminder Order Checks
Clinical Reminder order checks are defined at the site by
those who normally work on the Clinical Reminders package. The set-up of a
Clinical Reminders Order Check consists of two parts:
▪ Creating a group of orderable items to which the rules
should apply.
▪ Creating the rules that will be applied to the orderable
item when accepting an order in CPRS. It
will be possible to have the same orderable item in multiple groups. Each rule
assigned to the different groups will be evaluated when placing the orderable
item in CPRS. The order check groups and the rule will be stored in the
Reminder Order Check file.
Rules can either be defined to run against a reminder term
or a reminder definition. A reminder term is beneficial when the request is to
evaluate the presence of specific data (See Example #1). A reminder definition
is beneficial if you need the full functionality of a reminder definition to
determine if the rule should show in the order check form (See Example #2). The
user setting up the Clinical Reminder order check can define only one or the
other.
Note: Sites should evaluate all requests to
create a Clinical Reminder Order Check to determine the importance of adding
it. The more reminders that are used in an order check, the more they could
affect the performance of the order check system.
Example #1
Problem: An order check is needed for the interaction
between timolol ophthalmic (used to treat glaucoma) and over-the-counter (OTC)
antihistamines (which should not be used in the rarer narrow angle glaucoma).
Setup:
- Create a reminder term that looks for the presence of a diagnosis
of narrow angle glaucoma. (May need to look at multiple files depending on
your site practice)
- Create an Orderable Item Group that contains all orderable items
for any OTC Antihistamines.
- Create a Rule that contains the term created in step 1.
- Set the rule to trigger the order check if the reminder term is
evaluated at True.
- Create the text that should appear in the
order check window.
Example of the Output in CPRS:
This is an example of a Clinical
Reminders order check
Description of solution: A reminder
term was used in the setup because the presence of Glaucoma was all that is
needed to determine if the rule should trigger an order check. In the screen
shot above, the text "Diagnosis of Glaucoma" was defined in the
Display Name field. The rest of the text was defined in the Order Check Text
field.
Example #2
Problem: Order Check is needed when ordering Glyburide for
patients age 65 or greater and serum Cr 2.0 or greater.
Setup:
- Create a reminder definition that is applicable to the patient if
the patient age is 65 or greater and the patient has a CR serum 2.0 or
greater.
- Create an Orderable Item Group that contains all orderable items
for the Glyburide.
- Create a Rule that contains the definition created in step 1.
- Set the rule to trigger the order check if the reminder definition
is applicable to the patient.
- Create the text that should appear in the
order check window. Set the order text to display the finding output in
the order check text.
Example of the output in CPRS
This is an example of a Clinical
Reminders order checks that uses a rule and contains part of the definition
Description of solution: We needed
a reminder definition to match patients older than 64 who had a lab test with
the results greater than 2. In this example we set the rule up to display both
the order check text and the definition evaluation text. The text “Glyburide
Contraindicated” is the display name. The text “Avoid glyburide in patients
with a calculated creatinine clearance < 50 ml/min or a creating 2 or
greater. If an oral sulfonylurea is required, consider glipizide,” is defined
by the site. The rest of the text is returned from the reminder definition
evaluation.
Enabling Users to See the Reminders Order Checks
Clinical Reminder Order checks are defined with a testing
field. If the order check is being tested, the Clinical Application Coordinator
(CAC) or similar person sets this field in the Clinical Reminders order check definition
to True. Then, only users who have the Clinical Reminder Test order check set
to Yes will receive the order check—allowing a small number of users to test
the order check before it is enabled for all users in the facility.
Local Order Checks
These nationally released order checks are available on a
local CPRS system:
● Allergy-Contrast Media Interaction
● Allergy-Drug Interaction
● Aminoglycoside Ordered
● Biochem Abnormality For Contrast Media
● Clinical Reminder Live
● Clinical Reminder Test
● Clozapine Appropriateness
● Critical Drug Interaction
● CT & MRI Physical Limitations
● Dangerous Meds For Pt > 64
● Dispense Drug Not Selected
● Drug Dosage
● Duplicate Drug Class Order
● Duplicate Drug Order
● Duplicate Opioid Medications
● Duplicate Order
● Error Message
● Estimated Creatinine Clearance
● Glucophage-Contrast Media
● Glucophage-Lab Results
● Lab Order Freq Restrictions
● Missing Lab Tests For Angiogram Procedure
● No Allergy Assessment
● Order Checking Not Available
● Polypharmacy
● Recent Barium Study
● Recent Oral Cholecystogram
● Renal Functions Over Age 65
● Significant Drug Interaction
Several parameters that each site controls determine how
these order checks behave.
Order Check on Acceptance Dialog
For medication orders, if a possible problem is found, CPRS
displays the order check window, such as seen below when the user selects
Accept:
When
accepting a medication order, order checks are performed to identify potential
problems
The Order Checking dialog format separates the order check
texts and each order check is numbered using the “(1 of 2)” type format. Since
an allergy assessment has been performed, the Perform Allergy Assessment button
is disabled.
Order Checks Dialog on Signature Actions
If the clinician chooses to sign the order, CPRS displays
the following dialog:
The
Order Checks dialog shows the full text of the order check. In this example, an
item labeled “Checks marked with **** require reason for override” in red text
and with blue description text would require a justification for overriding it
This dialog displays each medication or other item that had
an order check in a separate section. Each item will have a check box allowing
the user to check any orders that should be canceled at this point. Under the
order text, the order checks are displayed, the most serious order checks are
listed first. Those that need a justification for overriding the order check
are displayed first, with the “Checks marked with **** require reason for
override” in red and are displayed with blue descriptive text in the body of
the order check. To accept these orders, the clinician must enter an override
reason.
Whether the order check requires the clinician to enter a
justification depends on how each site has set the severity for each order
check. For example, the Pharmacy package determines if an interaction is
critical or significant. Each site then determines whether the provider must
enter a reason for override for the Critical Drug Interaction and Significant
Drug Interaction order checks.
Another example would be allergy assessments. If the site
has the No Allergy Assessment order check set as an order check that requires
an override reason and the patient does not have an allergy assessment, then
the order will require a justification for override. If the site has No Allergy
Assessment as a moderate order check, CPRS does not require the clinician to
enter an override reason. As an alternative, the user can perform an allergy assessment
immediately by selecting the Perform Allergy Assessment button.
When a user enters an override reason, the reason for
override is sent with the orders to ancillary packages so that the information
is available to their users.
The dialog also has a View Monograph
button. The button will not be active unless there is a drug-drug interaction.
Selecting the See Monograph button will send the user to a monograph about the
drug or drug class to help the provider with additional information. If there
is more than one kind of drug, the Monographs for Order Checks dialog will
display a dropdown list with the choices for the various kinds of medications.
Remote Order Checks
Note: Remote order checks will be available at
sites when the RDI software, including patches OR*3.0*232, OR*3.0*238,
OR*3.0*267, GMRA*4.0*26, and GMRA*4.0*37, is installed at each site. The RDI
rollout is planned as a phased roll out that will last several months until all
sites have the software installed.
In addition, with the Remote Data Interoperability (RDI)
project, it is now possible to perform a limited number of order checks against
remote outpatient pharmacy and allergy information from other Veterans Health
Administration (VHA) facilities that is stored in the Health Data Repository
(HDR). Another project, the Clinical Health Data Repository (CHDR) will enable
remote order checks against allergies and outpatient medication data from
Department of Defense (DoD) facility data that is stored in the HDR. The CHDR
data only relates to active dual consumers (patients that are seen at both VHA
and DoD facilities).
For the selected patient, RDI requests from the HDR all
outpatient pharmacy data with an expiration or discontinued date starting 30
days in the past and going forward, including into the future.
What Remote Order
Checks Are Available?
With RDI and CHDR, the following order checks occur:
● Allergy Contrast Media Interaction
● Allergy-Drug Interaction
● Critical Drug Interaction
● Duplicate Drug Class Order
● Duplicate Drug Order
● Significant Drug Interaction
Which
Items Are NOT Used in Remote Order Checks?
Some items are not used in remote order checking because
they are not stored in the HDR. Others have a high annoyance factor and
therefore were not included at the request of field sites. The following items
are not included in remote order checks:
● Inpatient Medications
● Non-VA Meds
● Supply items
● Local drugs that are not matched to the National Drug
File
Note: The HDR-Hx and HDR-IMS contain prescriptions
with drugs that are not matched to the National Drug File (NDF). This
prescription data should be used in remote order checking for duplicate drug
classes. Because the National Drug File is updated regularly, these missing
order checks could be resolved whenever the NDF is updated. Some drugs may
never be matched, especially drugs used in research.
Will the Display
Change?
With RDI, if there is a problem with an
order check, CPRS displays the information to the user potentially in two
separate dialogs. The first dialog
displays the allergy order checks:
● It displays the facility name where the allergy was
recorded, the reactant, signs, severity, and symptoms.
● For remote allergies, the user is required to give a reason
for overriding order checks. The user is also able to write a local comment on
a remote facility allergy.
● Allergies are sorted by clinical danger level:
o
In cases where allergy
severity and symptoms are identical in one or more order checks, a single
consolidated order check will display. The sort order hierarchy is:
▪ First by Severity (Highest to Lowest).
▪ Second by Causative Agent.
▪ Last by Local and Remote locations.
The second dialog displays the following information:
● Medication orders include the last refill date and the
quantity.
● Remote medication order checks display the facility name
where the medication was prescribed. Local medication order checks do not
display the facility name.
This screen capture shows the Selected Medication Allergy Check with
remote facility names.
This
screen capture shows a duplicate therapy warning, a general dosing check, and a
message that the daily dose range check could not be performed because of
missing data
Allergies display the facility name
where the allergy was recorded. If there is more than one station, the local
station is displayed first.
To ensure that providers have the information they need,
CPRS also provides the message “Remote Order Checking not available – checks
done on local data only," as shown below, if CPRS cannot communicate with
remote sources.
If
CPRS cannot communicate with remote sources, it indicates this in the message
to the provider. The box and arrow are added here to show how the message will
display
CPRS shows this message once during an ordering session when
it cannot communicate with the HDR and then does not show it again until the
user begins another ordering session. However, after displaying the message,
CPRS continues to attempt communication with the HDR. If CPRS reaches the HDR,
remote order checks will appear when orders are placed.
How Is RDI Remote
Order Checking Enabled?
To use remote order checking, your site must enable a
parameter to access HDR data. This parameter is set for the entire facility.
When
Does CPRS Get Remote Data?
Order checks from CPRS can happen several times during a
CPRS ordering session:
● Beginning to write/copy/change orders – When a user selects
an order menu to begin writing orders, CPRS requests some order checks, such as
polypharmacy, renal function, or creatinine clearance, for example.
● On order acceptance – When the user selects Accept, CPRS
requests the order checks.
● Signature of orders – When a user signs the order, CPRS
requests order checks.
How Long Is the Data
Used?
A parameter that sites can set controls how long HDR data is
stored locally and is considered “fresh” and can be used for order checks
before the data will be retrieved again from the HDR. The default time for this
parameter is 120 minutes or two hours, but each site can change the time in
that parameter.
Quick Orders
A quick order is a predefined order that a user can select.
It has a value for some or all of the fields for the specific type of order
selected. For example, on an outpatient medication order, the user might define
the type of medication, dosage, route, and schedule, quantity, and number of
refills. If the user does not define a value for one or more mandatory fields,
CPRS will display the dialog for the user to fill in the missing values. Quick
orders can be created for many different types of orders. There are two types
of quick orders: personal and shared.
Personal Quick Orders
Personal quick orders are created when a user fills out the
order dialog, but before the user accepts the order, the user can select
Options | Save as Quick Order… and give the quick order a name. CPRS saves the
order, and it can then be used from that same dialog where it was created by
the user that created it. Personal quick orders display at the top of the list
of orders and are separated from the rest of the orders by a line.
For example, if a user creates a lab order and then saves it
as a personal quick order, the user will give the personal quick order a name
and that item will appear at the top of the lab order dialog with any other
personal quick orders, followed by a line and then the full list of lab orders
the next time that user opens the dialog.
To create a personal quick order, use these steps:
- Fill out an order dialog for a medication, lab, or other order that
you frequently place, but DO NOT select Accept.
- With the order dialog still up, select Options | Save as Quick
Order….
- In the Add Quick Orders (type) dialog,
where type is the package or type of order, such as Labs, Outpatient meds,
etc., enter a name for the quick order and select OK.
Note: You cannot save personal quick orders with the same name,
even if the capitalization is different.
To manage personal quick orders, use these steps:
- Open the appropriate ordering dialog (Outpatient Meds, Inpatient
Meds, Infusions, Labs, etc.).
- Select Options | Edit Common List….
- To rename a personal quick order, do the following:
1.
Highlight the personal
quick order name.
2.
Select the Rename button.
3.
In the Rename dialog,
type the new name for the personal quick order and select OK.
4.
Repeat steps a-c if
needed to rename additional orders.
- To change the position of a personal quick order in the list, do
the following:
a.
Highlight the personal
quick order name.
b.
Use the arrow buttons
to the left of the name list to move the name up or down to the chosen
position.
c.
Repeat steps a and b
if needed to arrange the list to your preference.
- To delete a quick order, do the following:
a.
Highlight the personal
quick order to be deleted.
b.
Select the Delete button.
c.
Repeat steps a and b
if needed to delete additional personal quick orders.
- When finished managing the personal quick
order list, select OK.
Shared Quick Orders
Shared quick orders are created in VistA by someone like a
Clinical Applications Coordinator (CAC). These quick orders can be made
available to all CPRS users by placing them on order menus, and can be used in
order sets.
Antimicrobial Medication Quick Orders
Tracking the use of antimicrobial drugs can be accomplished
by creating antimicrobial medication quick orders that contain “tracking
hooks.” There are two hooks: The |OR QUICK ORDER AUDIT| hook tracks clinically
preferred antimicrobial drug orders; the |OR QUICK ORDER AUDIT(ALT)| hook
tracks orders that prescribe an alternative to a clinically preferred
antimicrobial drug.
Note: Sites that
do not wish to track antimicrobial prescribing practices using quick orders, or
do not use the VISN 23 Antimicrobial Clinical Decision Support System (CDSS),
do not need to perform the setup steps for using the antimicrobial hooks and
reporting features described in this document.
Quick orders configured with either of the tracking hooks,
and the CPRS menus that provide access to these quick orders, must be set up by
a CAC or Office of Information and Technology (OIT) member. For information on
how to set up microbial medication quick orders with tracking hooks, refer to
the Computerized Patient Record System
(CPRS) Technical Manual: GUI Version.
Upon logging into CPRS, a clinician with permission to
prescribe antimicrobial drugs must navigate to the menu defined by the CAC
responsible for implementing quick order audit capabilities. This menu lists
available antimicrobial quick orders configured with a tracking hook. From this
menu, the clinician can prescribe the clinically preferred medication, or an
alternate drug, by selecting the quick order from the menu of available quick
orders.
Note: The menu
shown in the following example may be different from the implementation at your
site. This menu should be customized for the specific needs of facility
clinicians. Check with your CAC for more information.
In the following example, the menu is named “ANTIMICROBIAL
QUICK ORDERS” and displays when the ANTIMICROBIALS option is selected from the
Add New Orders menu. The site CAC may place this option elsewhere or use a
different name. This is intended as an example only.
To prescribe an
antimicrobial drug using a tracking quick order in CPRS:
- Navigate to the Add New Order menu and then
select ANTIMICROBIALS (or the equivalent option defined by your site CAC).
The ANTIMICROBIAL QUICK ORDERS menu displays.
Antimicrobials
menu option on the CPRS Add New Orders popup menu
Note: Quick orders listed on the ANTIMICROBIAL
QUICK ORDERS menu shown below are example quick orders containing either the
Primary (clinically preferred drug) or the Alternative (to a clinically
preferred drug) tracking hook.
The naming conventions for antimicrobial quick orders are
site specific. Your CAC may use an alternative naming schema for the quick
orders.
- Select a preconfigured quick order from the
ANTIMICROBIAL QUICK ORDERS menu or the equivalent menu configured for your
site.
Antimicrobial
Quick Orders menu listing preconfigured antimicrobial quick orders
The medications order form displays information about the
preconfigured quick order.
- Review the medication details and note the
“Pharmacy Confirmation #” displayed in the Comments field. This
confirmation number is added automatically whenever an antimicrobial drug
quick order is placed.
Outpatient
Medications form with Pharmacy Confirmation Number
- Select Accept to place the order or Quit to cancel without saving.
- Select Done to close the Antimicrobial
Quick Orders menu.
Entering Allergies from the Orders Tab
Although allergies and adverse reactions are not orders and
CPRS does not display them on the Orders
tab, you can enter allergies and adverse reactions from the Orders tab. You can also enter
allergies from the Cover Sheet tab.
(See “Entering Allergies” in the Assessing, Entering, and Reviewing
Allergies/Adverse Reactions” section of this manual.)
Entering New Allergies
To enter allergies or adverse reactions from the Orders tab, take the following
steps:
- Select the Orders tab.
- Select Allergies from the Write Orders
pane.
The Allergy Reactant Lookup dialog
appears.
Note: Your site may have defined and configured other order menus
to include allergy-entry dialogs. Regardless of the allergy-entry menu you
select, if you haven’t entered encounter information, the Location for Current Activities dialog appears before the Allergy Reactant Lookup dialog appears. You must complete the Location for Current Activities dialog
before proceeding.
- Type the causative agent in the search field. (You must enter the
first three letters (minimum) of the agent’s name.)
- Select Search.
Matching agents appear in the Select from one of the following items pane.
If the causative agent you typed does not match any of the agents currently
available for your site, CPRS displays the Causative
Agent Not On File dialog, from which you can select one of the following
options:
Note: The patient’s chart will not be updated unless you choose a
causative agent that is on file.
a. Yes:
Use this option to request that the causative agent be added for your site.
When you click Yes, CPRS displays
the Enter Optional Comments dialog,
which enables you to type additional comments (optional), such as the signs or
symptoms that occurred as a result of contact with this causative agent, or
whether you observed these symptoms firsthand. After you type your comments,
click Continue. CPRS then sends to
members of your site’s GMRA Request New Reactant mail group a message that
includes the following items:
o
The causative agent
you attempted to enter
o
The name of the
patient for whom you attempted to make this entry
o
Your name, title, and
contact information
o
Your comments
Note: When the bulletin is sent, a message such as the following
will display. This message also informs the user that the allergy was NOT
entered into the patient’s record.
“Members of your site’s GMRA
Request New Reactant mail group will review this message and, if appropriate,
add the causative agent to your site’s ALLERGIES file.”
Note: If your site’s IRM staff has not
yet added members to your site’s GMRA Request New Reactant mail group, CPRS
displays the following message:
CPRS displays this message if your
IRM staff has not yet added members to the GMRA Request New Reactant mail group
b.
No: Use this option if
you want to try an alternate spelling or trade name for your causative agent,
or if you want to type another causative agent.
c.
Cancel: Use this
option if you want to cancel your allergy order.
The Causative Agent Not On File
dialog
- If the causative agent you typed matches an
agent that is currently available for your site, select the agent. (Click
+ to expand a heading.)
Note: With CPRS GUI 24 or later, you may not add free-text
causative agents. If you select an item under the “Add new free-text allergy”
heading, CPRS displays the Causative
Agent Not On File dialog. (See Step 4 above.)
- Select OK.
The Enter
Allergy or Adverse Reaction dialog appears.
The Enter Allergy or Adverse Reaction dialog
Note: You can view a patient’s current allergies or adverse
reactions by clicking the Active
Allergies button. Also, CPRS no longer allows the user to change the
allergy Originator.
Note: If the provider has an NPI, it will display on the screen
above. See the "National Provider
Identifier (NPI) Display in CPRS" section for an example of an NPI
displaying on a screen.
- Use the Observed or Historical option
button to indicate whether the entry is for an observed or historical
allergy, respectively. (When you point your mouse at either of these
buttons, CPRS displays a hover hint explaining the observed and historical
options.)
Note: Observed or Historical used to have a default, but the user
must now select the appropriate choice. CPRS does not allow you to select
future dates for allergy/adverse reaction entries.
Note: When you select Observed for a drug reaction, CPRS generates
a Progress Note. Once this note is signed by the user entering the allergy or
by an administrative update user, the note will be viewable by all users.
- Select the Nature of Reaction (Allergy,
Pharmacological, or Unknown).
The Nature of Reaction (also known
as mechanism) can be Allergy, Pharmacologic, or Unknown. An allergic reaction
occurs because the patient is sensitive to a causative agent, regardless of the
amount the patient is exposed to. A pharmacologic (non-allergic) reaction
occurs when the patient is sensitive to an agent under certain conditions, such
as exposure to a large amount. Unknown is provided if you are not sure what
mechanism to enter.
Note:
Allergies are a subset of the world of adverse reactions. All allergies
are adverse reactions, but not all adverse reactions are allergies.
- If you are entering an
observed or historical allergy, use the Reaction Date/Time and Severity
boxes to select a reaction date, time, and severity. These are required for observed but
optional for historical allergies. (When the Severity box is visible, CPRS
displays a ? button next to it. If you click this button, CPRS displays
text that provides information about available severity selections.)
Note: CPRS does not allow you to enter
future dates for observed reactions.
- Using the Signs/Symptoms box, select one or
more signs or symptoms. The signs and symptoms you select appear in the
Selected Symptoms pane.
Note: You must enter
at least one Sign/Symptom or enter a comment of at least four characters when
documenting a historical allergy/adverse drug reason.
- To associate a date and time with a symptom optional), click to
select the symptom in the Selected
Symptoms pane.
- Select the Date/Time button located below
the Selected Symptoms pane.
CPRS displays
the Select Date/Time dialog, from
which you can select the date and time that the symptom first appeared.
Note: If
you mistakenly entered a sign or symptom but have not yet accepted it by
selecting OK, select the symptom in the Selected
Symptoms pane and click the Remove button
located beneath the pane.
- Type comments for the allergy in the Comments box.
- If you have marked the allergy or adverse
reaction on the patient’s identification (ID) band (or if you know someone
else has), select the ID Band Marked check box.
Note: CPRS activates the ID Band Marked check box only for
inpatients and then only if your site’s IRM staff has set a parameter
indicating your site wants to track this information. Depending on whether your IRM staff has set
related parameters, if you do not select
activated ID Band Marked check box, the system may send a bulletin
notifying a mail group that the patient’s allergy or adverse reaction is not
marked on his or her ID band.
- Select OK.
Note: When you click OK,
CPRS generates an email bulletin to the GMRA MARK CHART mail group. The
bulletin provides a reminder that the patient chart must be updated with the
allergy/adverse reaction information displayed in the bulletin message.
- If the newly entered
allergy is related to existing pending and active orders, then the
Existing Medication Allergy dialog is displayed for each order discovered,
as shown in the screenshot below:
- An Existing Medication Allergy will result in the NEW ALLERGY
ENTERED/ACTIVE MED notification being sent to the default providers
defined in the ORB PROVIDER RECIPIENTS parameter. Those providers who are able to receive
the notification are displayed.
Note, if a default provider recipient is unable to receive the
notification they will not be listed.
- The person entering the new allergy will
also be able to select Optional Recipients to receive the NEW ALLERGY
ENTERED/ACTIVE MED notification.
Note: Although CPRS does not display allergy-related assessments on
the Orders tab, you can also enter
an assessment of no known allergies (NKA) from the Orders tab.
Entering No Known Allergies
To enter a no-known allergies assessment from the Orders tab, follow these steps:
1.
Select the Orders tab.
2.
Select Allergies from the Write Orders pane.
The Allergy Reactant Lookup dialog
appears.
Note: Your site may have defined and configured other order menus
to include allergy-entry dialogs. Regardless of the allergy-entry menu you
select, if you haven’t entered encounter information, the Location for Current Activities dialog appears before the Allergy Reactant Lookup dialog appears. You must complete the Location for Current Activities dialog
before proceeding.
3.
Select the No Known
Allergies check box in the lower portion of the dialog box.
4.
Select OK.
Note: You can also enter a
no-known-allergies assessment from the Cover
Sheet tab.
Ordering Diets and Outpatient Meals
From the Orders tab, users can place diet orders for
inpatients and outpatients. For inpatients, users can place regular diet
orders, tube feeding orders, early/late tray orders, isolations/precautions
orders, and additional orders. For outpatients, users can place orders for
recurring meals, special meals, tube feeding, early/late tray,
isolations/precautions, and additional orders.
Some set up is required to use Outpatient meals. If it is
not working properly, contact your IRM or ADPAC staff. An overview of set up
issues is covered in the OR*3.0*215 Setup Notes.
The Nutrition and Food Service documentation is available on
the VistA Documentation Library (VDL) at http://www.va.gov/vdl/
under Nutrition and Food Service.
Note: If a user begins to enter an inpatient diet
and the patient already has a current or delayed diet order, CPRS will display
a dialog to tell the user that the existing meal could be replaced. The dialog
also shows the components of the existing diets.
CPRS
displays this Confirm dialog if the user begins to enter an inpatient diet that
will cancel and replace the current or delayed diet order
Note: If a user begins writing delayed diet orders
that conflict because start and stop dates are not well defined, CPRS will
display a dialog to inform the user that one of the diet orders may be replaced
and gives users some guidance.
The Possible delayed order conflict
dialog displays to ask the user if the user has checked a couple of items
Prevent Previous
Active Diet Replacing NPO Order Upon Expire, Discontinue, or Cancel
The dietetics
ordering functionality has been modified in order to prevent previous active diet orders replacing Nothing
Permitted Orally (NPO) orders upon expiration, DC, or cancellation. The
following changes have been made:
- The NPO orderable item will be added to the
Auto-DC Rules with the CPRS v31b installation. With this change, the
auto-DC rules will prevent the discontinuation of the NPO diet orders for
the following event types:
● Specialty transfer (S)
● OR (O)
● Transfer (T)
and the NPO diet remains
intact.
- When NPO diet orders are attempted to be manually discontinued,
CPRS prevents that action from being taken and displays the dialog box to
the user with text “NPO Diet cannot be discontinued."
- CPRS disallows all diet orders to have an Expiration Date/Time when
ordered and prevent automatic reinstatement of a previous diet. If a new
diet order is desired, a new diet must be ordered to replace the active
diet order.
- When ordering NPO, if a patient is currently on tube-feeding, the
provider is displayed the dialog box “The patient currently has an active
tubefeeding order <display the current tube-feeding order
here>"
- The Cancel Future Order Prompt from the tubefeeding order dialog
has been removed. A conversion routine has been created to remove the
prompt from any Quick Order. Additionally, Quick Orders will no longer
allow the features of Auto Accept or Verify.
- Accepting a tubefeeding order will prompt one of two different
messages depending on the current diet status of the patient. If there is
no existing order, the user will be prompted to enter a new diet order. If
an existing diet order is present, the user will be prompted to keep the
current diet or enter a new diet order.
How Discharge Affects Diet Orders
The Nutrition and Food Service (N&FS) VistA package
manages all diet-related order processing. The auto-discontinue process cannot
discontinue active diet orders.
If the diet is to be replaced, then a new diet should be
ordered.
Also, the rules for
auto-discontinuing (auto-dc) orders can be affected by how different VistA
packages handle discontinuing and how the package communicates with CPRS.
Depending on the set up and parameters, the results may be different that a
user might expect.
Note: If
discharging/readmitting patients the Nutrition & Food Service package will
auto-dc diet orders upon discharge. Plan to print diet lists pre-discharge so
that patient’s current diet and standing orders can be manually
re-entered/re-ordered upon admission.
Regular Inpatient Diet Orders
To place a regular diet order, follow these steps:
- Select the Orders tab.
- Select the active orders view from the View Orders pane. -or- select View | Active Orders
(includes pending, recent activity).
- Select Diet in the Write Orders list box.
- If there is a conflict, ensure that the
order you are entering will not create a problem with a current or delayed
diet order.
The Diet Order dialog box appears.
Note: The diet order may be
labeled differently or may not be available from your Write Orders list box.
Note: The encounter
information dialog may appear before the Diet Order dialog if you have not
entered encounter information. If the encounter information dialog appears,
enter the necessary information and select OK.
The Diet Order dialog allows you to
order several different types of diets
- Choose a diet from the Available Diet
Components list box on the Diet tab. (Quick orders are at the top of the
list).
The component that you select will
be displayed in the Selected Diet Components field. You can remove the
component by selecting it and clicking Remove.
- Enter the effective date and time and the expiration date and time
by doing one of the following:
●
entering a date (e.g.
6/21/01 or June 21, 2001).
●
entering a date
formula (e.g. t-200).
●
clicking the button to bring up a calendar.
- Select a delivery method from the Delivery field.
- Type in any special instructions.
- Select Accept Order.
Note: The order must be signed before it is sent. You can either
sign the order now or wait until later.
Inpatient Tube feeding Diet Orders
To place a tube feeding diet order, follow these steps:
- Select the Orders tab.
- Select the active orders view from the View
Orders pane.
-or-
select View | Active Orders
(includes pending, recent activity).
- Select Diet in the Write Orders list box.
- If there is a conflict, ensure that the
order you are entering will not create a problem with a current or delayed
diet order.
The Diet Order dialog will appear.
Note: The diet order may be
labeled differently or may not be available from your Write Orders field.
Note: If encounter information has not been entered,
the encounter information dialog appears before the Diet Order dialog. You must complete the encounter information
dialog before proceeding.
- Select the Tube feeding tab.
The Tube feeding tab on the Diet Order dialog
- Select a tube feeding product from the list.
- Select a strength and a quantity from the
grid on the right side of the dialog.
CPRS will automatically complete
the Amount field if it needs to multiply as a result of the schedule. If there
is a problem with the Quantity, CPRS displays a dialog to help the user know
how to enter an acceptable value:
Note: You can remove a product by selecting the product and
clicking Remove.
- If you would like to cancel future tray orders, select the “Cancel
Future TRAY Orders” checkbox.
- Enter any special instructions.
- Select Accept Order.
Early / Late Tray Diet Order
Early/Late Tray orders must be associated with an existing
diet order. Once these orders have been placed, they are separate from the
order with which they are associated. These orders do not discontinue
automatically if the existing order is discontinued.
To place an early / late tray diet order, follow these
steps:
- Select the Orders tab.
- Select the active orders view from the View Orders pane -or- select
View | Active Orders (includes pending, recent activity).
- Select Diet in the Write Orders list box.
- If there is a
conflict, ensure that the order you are entering will not create a problem
with a current or delayed diet order.
The Diet Order dialog will appear.
Note: The diet order may be
labeled differently or may not be available from your Write Orders list box.
Note: The encounter
information dialog may appear before the Diet Order dialog if you have not
entered encounter information. If the encounter information dialog appears,
enter the necessary information and click OK.
- Select the Early / Late Tray tab.
The Early / Late Tray tab
- Select Breakfast, Lunch, or Evening from
the Meal option group.
The appropriate meal times will
appear in the Meal Times option group.
- Select a meal time.
- Select a start and end date by doing one of the following:
● entering a date (e.g. 6/21/01 or June 21, 2001)
● entering a date formula (e.g. t-200)
● clicking the button to bring up a calendar
- Select which days the order will be effective from the Days of Week
option group.
- Select Accept Order.
Isolations/Precautions Order
To place an isolations/precautions order, follow these
steps:
- Select the Orders tab.
- Select the active orders view from the View
Orders pane –
or-
select View | Active Orders (includes pending, recent activity).
- Select Diet in the Write Orders list box.
- If there is a
conflict, ensure that the order you are entering will not create a problem
with a current or delayed diet order.
The Diet Order dialog will appear.
Note: The diet order may be
labeled differently or may not be available from your Write Orders field.
Note: If encounter
information has not been entered, the encounter information dialog appears
before the Diet Order dialog. You
must complete the encounter information dialog before proceeding.
- Select the Isolations / Precautions tab.
The Isolations / Precautions tab on
the Diet Order dialog box
- Select a type of precaution.
- Enter any necessary instructions in the Instructions field.
- Select Accept Order.
Additional Diet Order
To place an
additional diet order, follow these steps:
- Select the Orders tab.
- Select the active orders view from the View
Orders pane
-or-
select View | Active Orders
(includes pending, recent activity).
- Select Diet in the Write
Orders list box.
- If there is a conflict, ensure that the
order you are entering will not create a problem with a current or delayed
diet order.
The Diet Order dialog box will
appear
Note: The diet
order may be labeled differently or may not be available from your Write Orders
field.
Note: If
encounter information has not been entered, the encounter information dialog
appears before the Diet Order dialog.
You must complete the encounter information dialog before proceeding.
- Select the Additional Order tab.
The
Additional Diet Order tab
- Enter the text for the order in the Additional Diet Order field.
- Select Accept Order.
Outpatient Recurring Meals
Recurring meals for outpatients might be ordered if a
patient comes to a clinic regularly for treatment during meal times.
When the users select the Recurring Meal menu item, the
Outpatient Meals tab of the Diet Order dialog displays as shown below.
On
the Outpatient Meals tab of the Diet Order dialog, users can order recurring
meals for outpatients. In this example, the site set up LOW SODIUM as
Outpatient Diet 1, which is therefore the default that displays under Selected
Diet when the dialog first displays
Sites must set up the Available Diets
selections in the Nutrition and Food Service package through the List Manager
interface. Sites can designate up to 15 diets, the first of which is the
default. The 15 selections and their synonyms display under Available Diets for
selection when the user selects the drop-down list. The first diet is the
default and is displayed under Selected Diet when the user selects the
Recurring Meal menu item.
To order a recurring meal, use the following steps:
- Select the Orders tab.
- Select the active orders view from the View
Orders pane
-or-
select View | Active Orders
(includes pending, recent activity).
- Select Dietetic Orders from the Write Orders pane.
- Select Outpatient Recurring Meal.
- Select the appropriate diet under Available Diets or if the default
is correct, you may simply use it.
- Select the appropriate time (Breakfast,
Lunch, or Dinner) under Recurring Meal.
The default is none selected.
- Select a Start Date.
- Select an End Date.
- Select the method of Delivery.
- Select the days of the week that the meal should be given.
- Review the order text in the field at the bottom of the dialog for
accuracy.
- Select Accept Order.
- When finished, select Quit.
Special Meals
Users order special meals for a meal that must be ordered
today and is a one-time occurrence instead of a recurring meal. The same
Available Diets and default diet that sites defined recurring outpatient meals
are used in this dialog. Sites must set up the Available Diet selections in the
Nutrition and Food Service package through the List Manager interface. If these
outpatient diets are not set up, the user will not be allowed to order
outpatient meals.
Sites can designate up to 15 outpatient diets, the first of
which is the default. The 15 selections and their synonyms display under
Available meals for selection when the user selects the drop-down list. The
first diet is the default and is displayed under Selected Diet when the user
selects the Recurring Meal menu item.
Users
can order special meals for today only. They choose the diet, meal time, and
delivery method
If a special meal order generates a meal voucher, the meal
voucher requires a signature. If the user placing the order can authorize the
meal voucher (holds the FHAUTH key), the meal voucher will be “signed” when
that person signs the order in CPRS. If the ordering user cannot authorize it,
the meal voucher is printed without a signature and must be manually signed.
To order a special meal, use the following steps:
- Select the Orders tab.
- Select the active orders view from the View
Orders pane
-or-
select View | Active Orders (includes pending,
recent activity).
- Select Dietetic Orders
from the Write Orders pane.
- Select the Outpatient Special Meal menu item.
- Select the appropriate diet under Available Diets, or if the
default is correct, you may simply use it.
- Select the appropriate time (Breakfast, Lunch, or Dinner) under
Recurring Meal. The default is none selected.
- Select the method of Delivery.
- Review the order text in the field at the bottom of the dialog for
accuracy.
- Select Accept Order.
- When finished, select Quit.
Outpatient Tube Feeding Diet Orders
Outpatient tube feeding orders must be associated with a
recurring meal. If no recurring meal has been ordered for the selected patient,
CPRS displays a message informing the user and the user cannot order tube
feeding.
To place a tube feeding diet order, follow these steps:
- Select the Orders tab.
- Select the active orders view from the View Orders pane. -or-
select View | Active Orders (includes pending, recent activity).
- Select Dietetic Orders in the Write Orders
list box.
The Diet Order dialog will appear.
Note: The diet order may be
labeled differently or may not be available from your Write Orders field.
Note: If encounter
information has not been entered, the encounter information dialog appears
before the Diet Order dialog. You must complete the encounter
information dialog before proceeding.
- Select the Tube feeding tab.
The Tube feeding tab on the Diet Order dialog
- Select a tube feeding product from the list.
- Enter strength and a
quantity in the grid on the right side of the dialog.
CPRS will automatically complete
the Amount field if it needs to be multiplied as a result of the schedule. If
there is a problem with the Quantity, CPRS displays a dialog to help the user
know how to enter an acceptable value:
Note: You
can remove a product by selecting the product and clicking Remove.
- If you would like to cancel future tray orders, select the “Cancel
Future TRAY Orders” checkbox.
- Select the specific meal for which the tube feeding is being
ordered from the Start Date drop-down list.
- Enter any special instructions.
- Select Accept Order.
Early/Late Tray Outpatient Meal Order
Outpatient early/late tray orders must be associated with a
recurring meal. If no recurring meal has been ordered for the selected patient,
CPRS displays a message informing the user and the user cannot order the
early/late tray.
Once these orders have been placed, they are separate from
the order with which they are associated. These orders do not discontinue
automatically if the existing order is discontinued.
To place an early / late tray diet order, follow these
steps:
- Select the Orders tab.
- Select the active orders view from the View Orders pane -or- select
View | Active Orders (includes pending, recent activity).
- Select Dietetic Orders in the Write Orders
list box.
The Diet Order dialog will appear.
Note: The diet order may be
labeled differently or may not be available from your Write Orders list box.
Note: The encounter
information dialog may appear before the Diet Order dialog if you have not
entered encounter information. If the encounter information dialog appears,
enter the necessary information and select OK.
- Select the Early / Late Tray tab.
The Early / Late Tray tab
- Select Breakfast, Lunch, or Evening from
the Meal option group.
The appropriate
meal times display in the Meal Times option group.
- Select a meal time.
- Select the specific meal this order applies to from the drop-down
list.
- Select Accept Order.
Isolations/Precautions Order
To place an isolations / precautions order, follow these
steps:
- Select the Orders tab.
- Select the active orders view from the View Orders pane -or- select
View | Active Orders (includes pending, recent activity).
- Select Dietetic Orders in the Write Orders
list box.
The Diet Order dialog will appear.
Note: The
diet order may be labeled differently or may not be available from your Write
Orders field.
Note: If
encounter information has not been entered, the encounter information dialog
appears before the Diet Order dialog.
You must complete the encounter information dialog before proceeding.
- Select the Isolations / Precautions tab.
The
Isolations / Precautions tab on the Diet
Order dialog box
- Select a type of precaution.
- Enter any necessary instructions in the Instructions field.
- Select Accept Order.
Additional Outpatient Meal Order
To place an additional order for outpatient meals, follow
these steps:
- Select the Orders tab.
- Select the active orders view from the View Orders pane -or- select
View | Active Orders (includes pending, recent activity).
- Select Dietetic Orders in the Write Orders
list box.
The Diet Order dialog box will
appear
Note: The diet order may be
labeled differently or may not be available from your Write Orders field.
Note: If encounter
information has not been entered, the encounter information dialog appears
before the Diet Order dialog. You
must complete the encounter information dialog before proceeding.
- Select the Additional Order tab.
The Additional Diet Order tab
- Enter the text for the order in the Additional Diet Order field.
- Select the specific meal that this additional order applies to from
the Start Date drop-down box.
- Select Accept Order.
Ordering Medications
Using CPRS, providers can order inpatient and outpatient
medications with simple doses or complex doses. Providers can place medications
orders for unit dose or infusion orders for inpatients. Also, CPRS enables
providers to quickly order medications that will be given in clinics.
There are a few items that deal with how CPRS works that
providers need to be aware of when ordering medications, such as
● the need for inpatient mediations to have a valid schedule,
including the option to use the schedule builder
● a possible error if there is mismatch between the CPRS
order number and the pharmacy order number
● how CPRS displays unit dose routes
● how CPRS displays non-formulary drugs
● requirements for Clozapine treatment
This section then goes through how to order medications for
inpatients, outpatients, and patients seen in clinic. The various sections will
also include how to write medication orders for unit dose and infusion
orders.
Valid Routes for Inpatient Medications
Inpatient medication orders now require a valid schedule. If
users do not find the appropriate schedule in the list, they can choose to
create a day-of week/administration time schedule using the new Schedule
Builder. This feature also works for renewing and changing inpatient medication
orders. The procedure for ordering medications is described below.
Note: Because a valid schedule is required, if you
attempt to modify an existing medication order that does not have a valid
schedule, you will receive a message box stating that and will have to enter a
valid schedule.
Order Number Mismatch between CPRS and Pharmacy
When a user takes actions on an order, such as renewing,
changing, or discontinuing it, an infrequent error sometimes occurs where the
order number in CPRS and the order in Pharmacy do not match. In this case, CPRS
displays a warning that there is an “invalid pharmacy order number” and
instructing the user to contact someone in the Pharmacy service to complete the
action.
Rules for the Display of Unit Dose Routes in CPRS
CPRS displays unit dose routes based on the following rules:
- If a default medication route is defined in the orderable item
file, CPRS displays only the default medication route for the Unit Dose
orderable item in the medication route selection list.
- If there is no default medication route defined for the orderable
item, CPRS displays all possible medication routes for the dosage form to
the provider for selection.
- If there is only one possible medication route, it will be used as
the default.
- If a medication route name or its
abbreviation is not included in the selection list, a user may type it in.
How CPRS Designates Non-Formulary Drugs
Also, medications that are not in the formulary display in
the list with the letters “NF” after the name or synonym, which is also
displayed. CPRS checks for nonformulary dosages (e.g., the VA formulary may not
have a 2.5 MG pill, but it may have a 5.0 MG pill) and for non-formulary
orderable items (e.g., the VA may not carry a specific kind of allergy
medication).
New Clozapine Requirements
Note: The following information was provided by
the National Clozapine Coordination Project completed in
Mental Health patch YS*5.01*122.
Enhanced and new functionality includes updated FDA
guidelines for using ANC lab results exclusively for treating and monitoring
patients taking clozapine, as shown in the following table. The new guidelines
replace previous requirements which included both white blood cell (WBC) count
and ANC lab results. The Mental Health software’s code replaces the WBC/ANC
results combination and supports ANC values solely as the lab value of
choice.
Note: FDA REMS prescribed dosage and monitoring is
based on the ANC value only; however, VA requires
a matching WBC, indicating the WBC is from the same draw date/time as the ANC.
FDA ANC Levels and Monitoring Guidelines
|
ANC Level
|
ANC Monitoring
|
Frequency of ANC lab tests
|
|
Normal range
|
ANC
≥ 1500 cmm
|
Weekly (W) for patients 1 – 6 months on
therapy
Bi-weekly (B)
for patients 6 – 12 months on therapy
Monthly (M) for patients >12 months on
therapy
|
|
Mild neutropenia
|
1000 – 1499 cmm
|
ANC labs 3 times weekly until ANC stabilizes
to 1500 cmm or greater
|
|
Moderate neutropenia
|
500 – 999 cmm
|
ANC labs Daily until ANC stabilizes to 1000
cmm or greater, then 3 times weekly until ANC stabilizes to 1500 cmm or
greater
|
|
Severe neutropenia
|
< 500 cmm
|
ANC labs Daily until ANC stabilizes to 1000
cmm or greater, then 3 times weekly until ANC stabilizes to 1500 cmm or
greater
|
Note: The ANC unit of
measure is expressed as cells per cubic millimeter (cmm) which is equivalent to
cu mm, mm3 or µL.
|
Absolute Neutrophil Count (ANC) is lab test of
choice
|
Per the REMS document, “the WBC count is
required in order to calculate the ANC; however, ANC is a more relevant
indicator of drug-induced neutropenia than WBC count.”
New and enhanced functionality is based on the
presence of an ANC result in the last 7 days.
|
|
ANC less than 1000 cmm
|
The FDA recommends that clozapine treatment be
discontinued if the ANC is less than 1000 cmm; however, with correct
documentation and justification by the provider, the NCCC Director has the
discretion to continue treatment through a National Override.
|
Note: Recently the FDA
offered continuation of clozapine when a patient’s ANC result is less than 1000
cmm. To continue clozapine in this situation, VA requires the patient to sign a
special informed consent form in which the patient accepts the risks of continuation
and prescriber’s clinical justification for medical review is documented by the
Director of NCCC.
The other order checks related to
clozapine will continue to work as they have prior to these changes.
Additionally, the values of the Days Supply, Quantity, and
Refills fields are restricted based on the type of patient that Mental Health
designates in their files when the provider is ordering clozapine. This can be
a 7, 14, or 28-day recipient of the clozapine drug. For refills, the following
rules apply:
● Patients on a 7-day monitoring frequency have no refills
available.
● Patients on a 14-day monitoring frequency can receive a
full 14-day supply or a 7-day supply and ONE refill.
● Patients on a 28-day monitoring frequency can receive
EITHER a full 28day supply, or a 14-day supply and ONE refill, or a 7-day
supply and THREE refills.
CPRS now prevents the user from renewing outpatient and
inpatient clozapine orders.
Note: Clozapine orders
should not be renewed and each order for clozapine should be entered as a new
order. Renewal of clozapine is not allowed in CPRS from the Orders tab of the
chart and renew is also blocked in the VistA Pharmacy Software. CPRS currently
allows clozapine renewal from the CPRS Meds tab. This is a known issue and
users should not attempt to renew orders for clozapine.
Normal ANC Results
The FDA defines Normal – sometimes referred to as “safe” or
“passing” ANC results – as equal to or greater than 1500 cmm. When the system
identifies that the ANC results are Normal and a matching WBC is present, the
provider completes the prescription/order which is sent as a Pending Order to
pharmacy. There are no message updates in CPRS for a Normal ANC result.
Mild Neutropenia
The FDA defines Mild neutropenia as an ANC result from 1000
to 1499 cmm. New ANC lab test monitoring guidelines for Mild neutropenia are
presented to the ordering provider in a new CPRS message:
Test ANC labs 3x weekly until levels stabilize to greater
than or equal to 1500 cmm.
Moderate and Severe Neutropenia
FDA defines Moderate neutropenia as ANC 500-999 cmm and
severe neutropenia as ANC less than 500 cmm. Both Moderate and Severe
neutropenia require the same lab test monitoring guidelines as they are both
less than 1000 cmm. A new CPRS message includes:
Test ANC labs daily until levels stabilize to equal to or
greater than 1000 cmm, then test ANC labs 3x weekly until levels stabilize to
greater than or equal to 1500 cmm.
When there is Moderate or Severe neutropenia with a matching
WBC result present, a National Override
is required. If a matching WBC result is not present, the system will alert the
provider that the system will address the ‘No Matching WBC’ issue first. See
information on No Matching WBC.
Moderate and Severe Neutropenia – National Override in Effect
When a National Override for Moderate or Severe Neutropenia
has been approved by the NCCC and is in effect, modified CPRS screens display,
including instructions for testing ANC.
No ANC Results
The system relies on the presence of an ANC result to treat
patients receiving clozapine, with exceptions as noted to override in certain
conditions. The system requires an ANC within the last 7 days.
For registered patients with a history of normal ANC results, the requirement for a normal ANC
result in the last 7 days may be bypassed to meet an urgent need under special
conditions.
In CPRS, when the provider is
notified that there are no ANC results in the last seven days, they will decide
based on the following:
1.
Non-emergency
If this is not an emergency, the provider will request a National Override to
dispense the clozapine at the patient’s
normal frequency. When the National Override is authorized and recorded in
the local VistA system, the provider reenters the order and a Pending
prescription/order to dispense clozapine at the patient’s normal frequency is
sent.
For example, this may be used when:
a.
The patient’s last
blood test was done at another facility and isn’t in the local VistA system,
but the provider has seen the results
b.
The provider feels it
is unnecessary – perhaps the patient is at end of life or some other medical
condition – and there is no need to keep drawing blood
2.
Emergency 4-day supply
– Special Conditions Local Override
In an emergency where a 4-day supply is needed, the provider may choose
to use a Special Conditions Local Override which optionally allows a one-time 4-day emergency supply to be
dispensed for specific prescriber-approved reasons.
Note: A
written prescription or order is required.
Special Conditions Local Override is not supported in CPRS – no Pending Order
is available.
If the patient is an Outpatient,
the prescriber-approved reason must be one of the following:
1.
Weather-related
conditions
2.
Mail order delay
3.
Inpatient going on
leave
If the patient is an Inpatient,
the prescriber-approved reason will be:
1. IP Order Override with Outside Lab
Results
When there is No ANC result for the
last 7 days, a new CPRS screen displays notifying the provider of the missing
results. The top part of the new CPRS message indicates the option to request a
National Override when the condition is not
an emergency and clozapine is to be dispensed at the patient’s normal frequency.
If this is an emergency, the bottom
part of the new CPRS message is dependent on whether this is an Outpatient or
and Inpatient.
Outpatient
If this is an Outpatient, the second part of the message is
to instruct the provider to write a prescription and include an approved reason from the list.
Inpatient
If this is an Inpatient, the second part of the message is
to instruct the provider to write an order and include the single approved reason – IP Order Override with Outside Lab Results.
No Matching WBC (ANC Present)
When there is an ANC result in the last 7 days but no
matching WBC, regardless of whether it is a normal result or indicates mild or
moderate to severe neutropenia, the system will address the ‘No Matching WBC’
condition first. A warning message to the provider will require a National
Override in order to dispense clozapine. The system can only address one
condition at a time.
Note: A Matching WBC result
is collected at the same draw date/time as the ANC.
Emergency Registration Override
An Emergency Registration Override is typically warranted
for the following reasons:
- The patient has a current NCCC registration at another VistA
facility
o
Inpatient transferred
from another facility
o
Outpatient from
another facility becomes an inpatient
- The patient has never been registered at the local facility
- The patient status has changed from Active to Discontinued
- An Outpatient with a prescription that had
previously been filled outside of the VA or at another VA facility arrives
during NCCC non-duty hours
Note: A Clozapine
Authorization Number is only valid for a patient at the facility where they
were registered. When a Clozapine patient arrives at a new facility, they need
to be re-registered with a new Clozapine Authorization Number before the
facility’s CPRS and Pharmacy applications will allow a Clozapine order to be
processed.
If the patient is not actively registered at NCCC, this new
CPRS message displays to the provider prior to a hard stop:
*** This patient is not registered in the clozapine
treatment program or has been discontinued from the program. A new registration
number must be assigned. If this is not an emergency, contact the NCCC. For
emergency registration during non-NCCC duty hours, a written order to the
pharmacist can be used to process a registration override. ***
Ordering Inpatient
Medications (Simple Dose)
Note: If the user attempts to order inpatient
medications for an inpatient from an outpatient location, CPRS discontinues the
order process and returns the user to original Orders or Meds tab display.
To write a new inpatient medication order with a simple
dose, follow these steps:
1.
Select the Orders tab and select the appropriate
item in the Write Orders pane.
The Inpatient Medications dialog appears.
The Inpatient Medications order
dialog allows you to select from a list of personal quick orders or medication
2.
Locate the medication
name or quick order name in the list box by typing characters in the Medication
field.
Note: CPRS now only
auto-selects (highlights in blue and places that entry in the field) a
medication, dosage, route, or schedule if the user types enough characters to
uniquely identify an item in the list. If the user does not enter enough
characters to uniquely identify an item, CPRS waits until the user manually
selects an item using the mouse or the keyboard.
3.
Select the quick order
or medication name using the mouse or keyboard.
The lab results for the most recent
lab test associated with the selected medication are displayed in the
Information field, if an associated lab test was performed within the last 365
days.
Note: A CAC or ADPAC will
need to set the OR CPRS LAB DISPLAY ENABLED parameter to ON to activate the lab
results display at a site.
To view associated lab results for
Quick Orders, a TIU OBJECT must be inserted into the Quick Order. For more
information, refer to the Text Integration Utility (TIU) Clinical Coordinator
& User Manual. This functionality will work for generalized Quick Orders
only (orders assigned to Order Menus). It is not currently implemented for
personal Quick Orders.
The lab results functionality will
not work properly for multidivisional facilities or any sites that use
different lab test names at different sites, as only one lab test name can be
associated with each drug. To successfully implement this functionality, all
facilities/divisions that share a VistA system must use the same name for each
monitored lab test.
Note: CPRS now uses a look up from Pharmacy to
determine whether the selected medication is a controlled substance that
requires the signature of a provider with a DEA number. For controlled
substances, CPRS displays a message—“Order for controlled substance could not
be completed. Provider does not have a current, valid DEA# on record and is
ineligible to sign the order”—as shown in the graphic below. CPRS allows orders for controlled substances
only when selected providers are able to sign the orders. You may need to exit
the dialog, change the provider selection, and then reenter the dialog. See Appendix D: Error Messages and
Troubleshooting for a full list of error messages related to controlled
substance ordering.
You must have a DEA# to order
certain medications
Note: CPRS
requires a patient have a valid address if the selected outpatient medication
is a controlled substance that requires the signature of a provider with a DEA
number. For outpatient controlled substances, CPRS displays a message –
“Controlled substance prescriptions require a patient address. Please contact
administrative support to update patient address information.” if the patient
does not have a valid address. The contact information in the display may be
customized using the Enter/Edit Missing ZIP Code Message option in the GUI
Parameters menu.
Controlled
substance prescriptions require a patient address
4.
Selected the Dosage field and select a dosage.
The dosage may not begin with a
decimal, for example .5; it must begin with a numerical value, 0.5 for example.
Also, the character “^” may not be entered in the Dosage field. (The associated
cost is displayed to the right of the dosage.)
Once a dosage is selected, any lab
test results displayed in the Information field are replaced by the National
Standard Orderable Item information.
Note: CPRS now only
auto-selects (highlights in blue and places that entry in the field) a
medication, dosage, route, or schedule if the user types enough characters to
uniquely identify an item in the list. If the user does not enter enough
characters to uniquely identify an item, CPRS waits until the user manually
selects an item using the mouse or the keyboard.
5.
Enter a Route by either selecting one from the
list or typing in a valid route (a default route may have been set up).
6.
In the Schedule pane, select an existing
schedule from the list or, to use a day-of-week/administration time schedule
not on the list, select OTHER (you
can also click the Day-of-Week link and then click OK on the dialog that
displays).
When the user selects a schedule,
the administration times may display under the “Give additional dose now” text
for a simple dose. The administration times will display if they have been
defined for the ward or if there is a default as long as the schedule is not a
PRN schedule.
7.
If you selected an
existing schedule, skip to step 8. If you selected OTHER, CPRS displays the Order
with Schedule ‘OTHER’ dialog. Take the following steps:
a.)
Select one or more
checkboxes by the appropriate days of the week.
b.)
If the schedule
requires specific administration times skip to steps c and d. To select a
schedule from the list, highlight the schedule and select Add.
Note: Users can
assign either a schedule from the list or specific administration times, but
not both. Also, because the user is specifying days of the week and a schedule,
the list will contain only schedules less than 24 hours (for example, Q36H will
not be in the list).
c.)
To use a specific
administration time, select the hour and minutes (if the user only selects the
hour, the minutes will default to zero) and select Add.
d.)
Repeat step c until
you have entered all required administration times.
Warning: The administration times in
the Schedule field apply to each day of the week that is listed, such as
TU-TH-SA@08002000, for example. To create a schedule such as TU@0800 TH@2000,
users would have to enter two separate orders using the complex medication
order dialog. Also, users may not enter a schedule that only has administration
times and PRN but no days.
e.)
If you make a mistake
while selecting an administration time or schedule, do one of the following to
remove it:
o
For a single
administration time, highlight the hour and minutes in the Set Administration
Time fields and select Remove (so to
remove 08:00, you would have to select that time in the Set Administration Time
fields not in the Schedule text box.)
o
To remove the
schedule, highlight the schedule and select Remove.
o
To remove the entire
schedule and begin again with step a, select Reset.
f.)
Review the Schedule field.
g.)
When you have the
correct schedule, select OK.
The Order with Schedule ‘OTHER’ dialog allows you to enter a customized
day-of-week and/or administration-time schedule. The user can enter specific
administration times or select a schedule from the available list
8.
Select PRN if necessary.
PRN will display in the schedule
field if the PRN checkbox is checked or if the schedule is defined in the
Pharmacy files as a PRN schedule.
9.
Enter an Indication.
If indications are defined, they will display in the drop-down list for you to
select or you may type in an indication
10.
Enter comments
(optional).
The date and time that the patient
is scheduled to receive the first dose of the medication appears under the Comments field. (For example, CPRS
cannot show an expected first dose for “on call” or schedules with PRN. On the
complex tab, it will not try to determine an expected first dose after a THEN
because the first item must be completed.) If you want the patient to receive
an additional dose now, check the Give
additional dose now check box.
When you
select the Give additional dose now
check box, CPRS creates two new orders. Depending on your version of CPRS, the
order priority and dosing schedule may be set automatically or may require
manual adjustments. The pop-up messages displayed will also vary.
The dosing schedule and priority
are set automatically for each order. The first order is scheduled for
immediate administration (NOW) and is assigned the priority ASAP. The second
order is given the priority ROUTINE and will be administered following the
dosing schedule that you defined. A warning displays that is similar to the
following example.
Note: If your site does not use the priority ASAP,
then an alternative priority (for example, STAT) will display in place of ASAP.
Warning displayed when “Give
additional dose now” is selected
10.
Check the warning
message to ensure that the orders you created are what you expected. If the
orders are acceptable, then click OK.
If not, click Cancel to clear the Give additional dose now check box.
11.
Select a value for the
Priority field.
When Give additional dose now is selected, the Priority field is automatically set to ASAP (or a site-specific
alternative). If you select a value for the Priority field before you select the Give additional dose now checkbox, a message notifies you that the
selected priority will be changed to the “Give additional dose now” priority
settings.
CPRS displays a notification that
“Give additional dose now” overrides any previously selected priority
The default value of ASAP can be
changed by selecting a different value from the Priority field before submitting the order. If the Priority field is empty when the order
is submitted, it will revert to the default values for “Give additional dose
now.”
12.
Select Accept Order.
Note: If
you do not complete the mandatory items or if the information is incorrect,
CPRS sends a message telling you that the information is incorrect and showing
you the correct type of response.
13.
(Conditional) If the
medication ordered may be contraindicated because of allergies, drug
interactions, or duplicate orders, CPRS will display the Order Check window.
Carefully review all order checks and decide if the medication should be
ordered. Do one of the following:
o
To proceed, select
Accept Order.
o
To stop the ordering
process and return to the dialog, Cancel Order.
14.
Enter another
medication order
-or-
select Quit.
Note: You must sign the order before CPRS sends it
to Pharmacy. You can either sign the order now or wait until later. When using
Give additional dose now, it is recommended that you sign the order immediately
to send the order to the inpatient pharmacy. You only need to sign once for
both orders created when Give additional dose now is selected.
Ordering Inpatient Medications (Complex Dose)
Note: If
the user attempts to order inpatient medications for an inpatient from an
outpatient location, CPRS discontinues the order process and returns the user
to original Orders or Meds tab display.
In a complex dose order, the user must define specific
characteristics for the order. Because the dose can affect the quantity, for
example, changing certain fields may cause the quantity field to either
recalculate or reset to zero to force the user to enter the quantity.
To write a new Inpatient Medications order with a complex
dose, follow these steps:
- Click the Meds tab and select Action | New
Medication…
-or-
click the Orders tab and select the appropriate
item under the Write Orders list
box.
The Inpatient
Medications dialog box displays.
- In the Medication Order dialog, locate the
medication name or quick order name in the list box by typing characters
in the Medication field.
Note: CPRS now only
auto-selects (highlights in blue and places that entry in the field) a
medication, dosage, route, or schedule if the user types enough characters to
uniquely identify an item in the list. If the user does not enter enough
characters to uniquely identify an item, CPRS waits until the user manually
selects an item using the mouse or the keyboard.
- Select the quick order or medication name
using the mouse or keyboard.
Once the name is selected, CPRS
displays a second dialog to select the items for the rest of the order. In the
top field of the second dialog, the generic medication name and the synonym
(usually a brand name) are displayed.
The lab results for the most recent
lab test associated with the selected medication are displayed in the
Information field, if an associated lab test was performed within the last 365
days.
Note: A CAC or ADPAC will
need to set the OR CPRS LAB DISPLAY ENABLED parameter to ON to activate the lab
results display at a site.
To view
associated lab results for Quick Orders, a TIU OBJECT must be inserted into the
Quick Order. For more information, refer to the Text Integration Utility (TIU) Clinical Coordinator & User Manual.
This functionality will work for generalized Quick Orders only (orders assigned
to Order Menus). It is not currently implemented for personal Quick Orders.
The lab results functionality will
not work properly for multi-divisional facilities or any sites that use
different lab test names at different sites, as only one lab test name can be
associated with each drug. To successfully implement this functionality, all
facilities/divisions that share a VistA system must use the same name for each
monitored lab test.
Note: If the selected
medication is a controlled substance that requires the signature of a provider
with a DEA number, the Order not
completed dialog appears. CPRS allows orders for controlled substances only
when selected providers are able to sign the orders. You may need to exit the Medication Order dialog, change the
provider selection, and then reenter the dialog.
You must have a DEA# to order
certain medications
Note: CPRS requires a
patient have a valid address if the selected outpatient medication is a
controlled substance that requires the signature of a provider with a DEA
number. For outpatient controlled substances, CPRS displays a message –
“Controlled substance prescriptions require a patient address. Please contact
administrative support to update patient address information.” if the patient
does not have a valid address. The contact information in the display may be
customized using the Enter/Edit Missing ZIP Code Message option in the GUI
Parameters menu.
Controlled substance prescriptions
require a patient address
- Select the Complex tab.
Note: After you begin a
complex dose medication order, you must remain on the Complex tab until you finish the order. If you switch to the Dosage tab, CPRS clears all complex
dosages and you will be forced to start again.
- Select the Dosage field and select the
appropriate dosage.
The dosage may not begin with a
decimal, for example .5; it must begin with a numerical value, 0.5 for example.
Also, the character “^” may not be entered in the Dosage field. (The associated
cost is displayed to the right of the dosage.)
Note: CPRS
now only auto-selects (highlights in blue and places that entry in the field) a
medication, dosage, route, or schedule if the user types enough characters to
uniquely identify an item in the list. If the user does not enter enough
characters to uniquely identify an item, CPRS waits until the user manually
selects an item using the mouse or the keyboard.
Once a dosage is selected, any lab
test results displayed in the Information field are replaced by the National
Standard Orderable Item information.
- Enter a Route by either selecting one from the list or typing in a
valid route.
- In the Schedule pane, select an existing
schedule from the list or, to use a day-of-week/administration time
schedule not on the list, select OTHER.
When the user selects a regular
schedule that does not have PRN, the administration times may display in the
Schedule column. The administration times will display if they have been
defined for the ward or if there is a default.
- If you selected an existing schedule, skip to step 9. If you
selected OTHER, CPRS displays the Order with Schedule ‘OTHER’ dialog. Take
the following steps:
a.
Select one or more
checkboxes by the appropriate days of the week.
b.
If the schedule
requires specific administration times skip to steps c and d. To select a
schedule from the list, highlight the schedule and select Add.
Note: Users can
assign either a schedule from the list or specific administration times, but
not both. If launched from the Complex tab, the Day-of-Week Schedule builder
does not display one-time schedules in the schedule list. Also, because the
user is specifying days of the week and a schedule, the list will contain only
schedules less than 24 hours (for example, Q36H will not be in the list).
c.
To use a specific
administration time, select the hour and minutes (if the user only selects the
hour, the minutes will default to zero) and select Add.
d.
Repeat step c until
you have entered all required administration times.
Warning: The administration times in the Schedule field apply to
each day of the week that is listed, such as TU-TH-SA@08002000, for example. To
create a schedule such as TU@0800 TH@2000, users would have to enter two
separate orders using the complex medication order dialog. Also, users may not
enter a schedule that only has administration times and PRN but no days.
e.
If you make a mistake
while selecting an administration time or schedule, do one of the following to
remove it:
o
For a single
administration time, highlight the hour and minutes in the Set Administration
Time fields and select Remove (so to
remove 08:00, you would have to select that time in the Set Administration Time
fields not in the Schedule text box.)
o
To remove the
schedule, highlight the schedule and select Remove.
o
To remove the entire
schedule and begin again with step a, select Reset.
f.
Review the Schedule field.
g.
When you have the
correct schedule, select OK.
The Order with Schedule ‘OTHER’ dialog allows you to enter a customized
day-of-week and/or administration-time schedule. The user can enter specific
administration times or select a schedule from the available list
- If necessary, select PRN.
PRN will display in the schedule
field if the PRN checkbox is checked or if the schedule is defined in the
Pharmacy files as a PRN schedule.
- Select the Duration field and select the amount of time that the
patient should use the specified dose.
- In the then/and field, select the
appropriate conjunction for the order.
Note: The conjunction
“Then” requires a duration to be added.
- Select the next row in the Dosage field and
type or select a dosage.
The dosage may not begin with a
decimal, for example .5; it must begin with a numerical value, 0.5 for example.
Also, the character “^” may not be entered in the Dosage field. (The associated
cost is displayed to the right of the dosage.)
- CPRS fills in the Route and Schedule fields. You can change the
values in these fields if necessary.
- Select a duration and a conjunction (then
or and) except on the final row.
Note: Your site’s IRM staff
may have specified rules governing the status of inpatient medication orders
when patients are transferred from one ward or service to another. It may have
also specified the number of days an inpatient medication order remains active.
Please check with your site’s IRM staff for information about these rules.
- Repeat steps 12-14 until you have completed
the complex dose.
Note: You
can also add or remove a row in the complex dose. To add a row, click the gray area in front of
the row and click Add Row (CPRS
places the new row above the selected row). To delete a row, click the gray
area in front of the row you wish to delete and click Delete Row.
- Enter an Indication. If indications are defined, they
will display in the drop-down list for you to select or you may type in an
indication.
- Add comments (optional).
The date and time that the patient
is scheduled to receive the first dose of the medication appears under the Comments field. (For example, CPRS
cannot show an expected first dose for “on call” or schedules with PRN. On the
complex tab, it will not try to determine an expected first dose after a THEN
because the first item must be completed). If you want the patient to receive
an additional dose now, select the Give
additional dose now check box.
If you select the check box, the Give Additional Dose Now for Complex
Order warning dialog box appears, as shown below.
CPRS displays a warning to providers
who select “Give additional dose now” when placing a complex order
When you select the Give additional dose now check box,
CPRS creates two new orders. Depending on your version of CPRS, the order
priority and dosing schedule may be set automatically or may require manual
adjustments. The pop-up messages displayed will also vary.
The dosing schedule and priority
are set automatically for each order. The first order is scheduled for
immediate administration (NOW) and is assigned a priority of ASAP (or a
site-specific alternative). The second order is given the priority ROUTINE and
follows the regular dosing schedule that you defined when placing the order.
If you select a value for the Priority field before you select the Give additional dose now checkbox, a
message notifies you that the selected priority will be changed to the “Give
additional dose now” priority settings.
Note: If your site does not use the priority ASAP, then an
alternative priority (for example, STAT) will display in place of ASAP.
Warning displayed when “Give
additional dose now” is selected
- Check the orders and then select OK to close the
warning dialog.
- Choose a priority from the Priority
drop-down list.
When Give additional dose now is selected, the Priority field is automatically set to ASAP (or a site-specific
alternative). If you select a value for the Priority field before you select the Give additional dose now checkbox, a message notifies you that the
selected priority will be changed to the “Give additional dose now” priority
settings.
CPRS displays a notification that
“Give additional dose now” overrides any previously selected priority
- Select Accept Order.
Note: If you do not
complete the mandatory items, or if the information is incorrect, CPRS sends a
message to tell you that the information is incorrect and shows you the correct
type of response.
- (Conditional) If the medication ordered may be contraindicated
because of allergies, drug interactions, or duplicate orders, CPRS will
display the Order Check window. Carefully review all order checks and
decide if the medication should be ordered. Do one of the following:
o
To proceed, select
Accept Order.
o
To stop the ordering
process and return to the dialog, Cancel Order.
- Enter another medication order
-or-
select Quit.
Note: You must sign the
order before CPRS sends it to the Pharmacy package. You can either sign the
order now or wait until later.
When using Give additional dose
now, it is recommended that you sign the order immediately to send the order to
the inpatient pharmacy. You need only sign once for both orders created when
Give additional dose now is selected.
Ordering Clinic Medications
Clinic Medications enables a CPRS user to order unit-dose
medications that are dispensed by inpatient pharmacy and administered to a
patient in a clinic setting, as well as nursing text orders. Clinic Medications
also use VistA order checks.
On the Orders tab, CPRS displays these medications and
Nursing text orders under a new display group named Clinic Medications. To show
under the Clinic Medications display group, Nursing text orders must be written
from a clinic location. If they are not ordered from a clinic location, the
Nursing text orders will display under the Nursing display group. This includes
text orders that are part of an order set.
Note: If Clinic Nursing orders do not display where
expected, they may not be set up properly. IRM or CAC personnel should check
the CPRS Technical Manual: GUI Version
for more information.
This
example shows the Order tab with a unit dose and nursing text order--that
appear under the Clinic Medications display group
Note: If a
provider has an NPI, it will not display on the screen above.
On the Meds tab, Clinic medication orders of all statuses
display at the top of the Inpatient Medications pane before other inpatient
medications orders. Nursing text orders do not display on the Meds tab. Users
can distinguish Clinic orders because they have an entry in the Location column
of the Meds tab display.
Note: Clinic
Medication orders are affected by both CPRS auto-DC rules and Inpatient
Medications rules for auto-discontinuing orders on admission and discharge. If
sites do not want Clinic orders to auto-discontinue on admission and discharge,
sites will have to ensure that neither CPRS nor Inpatient Medications
discontinues Clinic orders. Inpatient Medications uses the AUTO-DC IMO ORDERS
parameter to exclude Clinic orders from being discontinued.
Criteria for Clinic Medications
To successfully write Clinic medication orders, the
encounter must be in a clinic location.
Note: To
create a new visit, select the Provider/Encounter button (shown below), select
the Visit tab, select New, and then select OK.
In addition, before you can use the Meds tab to place Clinic orders, your site’s CAC (or the person who
manages information resources at your site) must set up the new medication
order dialog to include inpatient medications.
Ordering Simple Clinic Medications
To write a simple
Clinic Medication order, use these steps:
- Select the Orders tab.
- From the Write Orders pane, select Clinic
Medications.
Note: Depending on how menus are set up at your
particular site, you may need to select a different option from the Write
Orders pane. Many sites have customized the items in the Write Orders pane.
Check with your CAC (or the person who manages information resources at your
site) if you have trouble locating the Clinic Medications item.
Note: The
following prompts will be slightly different based on the patient’s location.
You will be asked to verify that you want to write Clinic Medications and to
ensure that the encounter location is a clinic location.
- If prompted, enter the appropriate clinic
for the encounter information. This will generally happen with an
outpatient.
You can use an existing appointment if one exists or create
a new one. To use Clinic Medications, you must enter a location that was
previously defined clinic. If you chose a clinic location, you will see this
dialog.
This
dialog is to ensure that the user knows they are about to enter Clinic
Medications
- To continue ordering Clinic Medications, select Yes and continue to
the next step. To stop the Clinic Medications process, choose No.
- (Conditional) If the patient’s current location is not a clinic,
you will be asked if you want to change the patient’s location.
- In the Clinic Medications dialog, locate
the medication name or quick order name in the list box by typing
characters in the Medication field.
Note: CPRS now only auto-selects (highlights in
blue and places that entry in the field) a medication, dosage, route, or
schedule if the user types enough characters to uniquely identify an item in
the list. If the user does not enter enough characters to uniquely identify an
item, CPRS waits until the user manually selects an item using the mouse or the
keyboard.
- Select the quick order or medication name
using the mouse or keyboard.
Note: If the selected medication is a controlled
substance that requires the signature of a provider with a DEA number, the Order not completed dialog appears.
CPRS allows orders for controlled substances only when selected providers are
able to sign the orders. You may need to exit the dialog, change the provider
selection, and then reenter the dialog.
You
must have a DEA# to order certain medications
Note:
CPRS requires a patient have a
valid address if the selected outpatient medication is a controlled substance
that requires the signature of a provider with a DEA number. For outpatient
controlled substances, CPRS displays a message – “Controlled substance
prescriptions require a patient address. Please contact administrative support
to update patient address information.” if the patient does not have a valid
address. The contact information in the display may be customized using the
Enter/Edit Missing ZIP Code Message option in the GUI Parameters menu.
Controlled substance prescriptions
require a patient address
- Select the appropriate Dosage from the list
if displayed. If it is not displayed, you can enter a free-text dosage.
The dosage may not begin with
a decimal, for example .5; it must begin with a numerical value, 0.5 for
example. Also, the character “^” may not be entered in the Dosage field. (The
associated cost is displayed to the right of the dosage.)
- Enter the Route by either selecting one from the list or typing in
a valid route (a default route may have been set up).
- In the Schedule pane, select an existing
schedule from the list or, to use a day-of week/administration time
schedule not on the list, select OTHER (you can also click the Day of-Week
link and then click OK on the dialog that displays).
When the user selects a
schedule, the administration times may display under the “Give additional dose
now” text for a simple dose. The administration times will display if they have
been defined for the ward or if there is a default as long as the schedule is
not a PRN schedule.
- If you selected an existing schedule, skip to step 12. If you
selected OTHER, CPRS displays the Order with Schedule ‘OTHER’ dialog. Take
the following steps:
a.
Select one or more
checkboxes by the appropriate days of the week.
b.
If the schedule
requires specific administration times skip to steps c and d. To select a
schedule from the list, highlight the schedule and select Add.
Note: Users can assign
either a schedule from the list or specific administration times, but not both.
Also, because the user is specifying days of the week and a schedule, the list
will contain only schedules less than 24 hours (for example, Q36H will not be in
the list).
c.
To use a specific
administration time, select the hour and minutes (if the user only selects the
hour, the minutes will default to zero) and select Add.
d.
Repeat step c until
you have entered all required administration times.
Warning: The administration times in the Schedule field apply to
each day of the week that is listed, such as TU-TH-SA@08002000, for example. To
create a schedule such as TU@0800 TH@2000, users would have to enter two
separate orders using the complex medication order dialog. Also, users may not
enter a schedule that only has administration times and PRN but no days.
e.
If you make a mistake
while selecting an administration time or schedule, do one of the following to
remove it:
o
For a single
administration time, highlight the hour and minutes in the Set Administration
Time fields and select Remove (so to
remove 08:00, you would have to select that time in the Set Administration Time
fields not in the Schedule text box.)
o
To remove the
schedule, highlight the schedule and select Remove.
o
To remove the entire
schedule and begin again with step a, select Reset.
f.
Review the Schedule field.
g.
When you have the
correct schedule, select OK.
The Order with Schedule ‘OTHER’ dialog allows you to enter a customized
day-of-week and/or administration-time schedule. The user can enter specific
administration times or select a schedule from the available list
- Select PRN if necessary.
PRN will display in the
schedule field if the PRN checkbox is checked or if the schedule is defined in
the Pharmacy files as a PRN schedule.
- Enter an Indication. If indications are defined, they
will display in the drop-down list for you to select or you may type in an
indication.
- (Optional) Enter a Comment if desire by moving the cursor to the
field and typing the comment.
- The date and time that the patient is scheduled to receive the
first dose of the medication appears under the Comments field. (For
example, CPRS cannot show an expected first dose for “on call” or
schedules with PRN. On the complex tab, it will not try to determine an
expected first dose after a THEN because the first item must be
completed).
- If you want the patient to receive an
additional dose now, check the Give additional dose now check box. When
you click the check box, CPRS creates two new orders. Depending on your
version of CPRS, the order priority and dosing schedule may be set automatically
or may require manual adjustments. The pop-up messages displayed will also
vary.
The dosing schedule and priority are
set automatically for each order. The first order is scheduled for immediate
administration (NOW) and is assigned the priority ASAP. The second order is
given the priority ROUTINE and will be administered following the dosing
schedule that you defined. A warning displays that is similar to the following
example.
Note: If
your site does not use the priority ASAP, then an alternative priority (for
example, STAT) will display in place of ASAP.
Warning
displayed when “Give additional dose now” is selected
- Check the warning message to ensure that the orders you created are
what you expected. If the orders are acceptable, click OK. If not, click
Cancel to clear the Give additional dose now check box.
- Select a value for the Priority field.
When Give additional
dose now is selected, the Priority
field is automatically set to ASAP
(or a site-specific alternative). If you select a value for
the Priority field before you select
the Give additional dose now
checkbox, a message notifies you that the selected priority will be changed to
the “Give additional dose now” priority settings.
CPRS
displays a notification that “Give additional dose now” overrides any
previously selected priority
The default value of ASAP can be changed by selecting a
different value from the Priority
field before submitting the order. If the Priority
field is empty when the order is submitted, it will revert to the default
values for “Give additional dose now.” Select Accept Order.
Note: If you do not complete the mandatory items or
if the information is incorrect, CPRS sends a message telling you that the
information is incorrect and showing you the correct type of response.
- (Conditional) If the medication ordered may be contraindicated
because of allergies, drug interactions, or duplicate orders, CPRS will
display the Order Check window. Carefully review all order checks and
decide if the medication should be ordered. Do one of the following:
●
To proceed, select
Accept Order.
● To stop the ordering process and return to the dialog,
Cancel Order.
- Enter another medication order
-or-
select Quit
When you select Quit, if the patient is in inpatient, CPRS
changes the patient’s location back to where the patient was before changing to
the clinic.
Note: You
must sign the order before CPRS sends it to Pharmacy. You can either sign the
order now or wait until later. When using Give additional dose now, it is
recommended that you sign the order immediately to send the order to the
inpatient pharmacy. You only need to sign once for both orders created when
Give additional dose now is selected.
Ordering Complex Clinic
Medication Orders
CPRS enables providers to place complex Clinic Medication
orders. These orders must be placed from a clinic location. CPRS will ask you
to confirm that you are placing a Clinic Medication order. You will also have
to change the encounter location to an appropriate clinic. For outpatients, you
will be prompted if no encounter location has been defined yet and then asked
to confirm that you want to order Clinic Medications. For inpatients, you will
be asked to confirm that you want to order Clinic Medications first and then
prompted for an appropriate clinic location.
In a complex dose order, the user must define specific
characteristics for the order.
Because the dose can affect the quantity, for example,
changing certain fields may
cause the quantity field to either recalculate or reset to
zero to force the user to enter the quantity.
To order complex
Clinic Medication orders, use the following steps:
- Select the Orders tab.
- From the Write Orders pane, select Clinic
Medications.
Note: Depending on how menus are set up at your
site, you may need to select a different option from the Write Orders pane.
Many sites have customized the items in the Write Orders pane. Check with your
CAC (or the person who manages information resources at your site) if you have
trouble locating the Clinic Medications item.
Note: The following prompts will be slightly
different based on the patient’s location. You will be asked to verify that you
want to write Clinic Medications and to ensure that the encounter location is a
clinic location.
- If prompted, enter the appropriate clinic
for the encounter information. This will generally happen with an
outpatient that does not yet have an encounter defined.
You can use an existing
appointment if one exists or create a new one. To use Clinic Medications, you
must enter a location that was previously defined clinic. If you chose a clinic
location, you will see this dialog.
This
dialog is to ensure that the user knows they are about to enter Clinic
Medications
- To continue ordering Clinic Medications, select Yes and continue to
the next step. To stop the Clinic Medications process, choose No.
- (Conditional) If the patient’s current location is not a clinic,
you will be asked if you want to change the patient’s location.
- In the Clinic Medications dialog, locate
the medication name or quick order name in the list box by typing
characters in the Medication field.
Note: CPRS now only auto-selects (highlights in
blue and places that entry in the field) a medication, dosage, route, or
schedule if the user types enough characters to uniquely identify an item in
the list. If the user does not enter enough characters to uniquely identify an
item, CPRS waits until the user manually selects an item using the mouse or the
keyboard.
- Select the quick order or medication name
using the mouse or keyboard.
Once the name is selected,
CPRS displays a second dialog to select the items for the rest of the order. In
the top field of the second dialog, the generic medication name and the synonym
(usually a brand name) are displayed.
Note: If the selected medication is a controlled substance that requires
the signature of a provider with a DEA or VA number, the Order not completed dialog appears. CPRS allows orders for
controlled substances only when selected providers are able to sign the orders.
You may need to exit the Medication Order
dialog, change the provider selection, and then reenter the dialog.
You
must have a DEA# to order certain medications
Note: CPRS requires a patient have a valid
address if the selected outpatient medication is a controlled substance that
requires the signature of a provider with a DEA number. For outpatient
controlled substances, CPRS displays a message – “Controlled substance prescriptions
require a patient address. Please contact administrative support to update
patient address information.” if the patient does not have a valid address. The
contact information in the display may be customized using the Enter/Edit
Missing ZIP Code Message option in the GUI Parameters menu.
Controlled
substance prescriptions require a patient address
- Select the Complex tab.
Note: After you begin a complex dose medication
order, you must remain on the Complex tab until you finish the order. If you
switch to the Dosage tab, CPRS clears all complex dosages and you will be
forced to start again.
- Select the Dosage field and select the
appropriate dosage.
The dosage may not begin with
a decimal, for example .5; it must begin with a numerical value, 0.5 for
example. Also, the character “^” may not be entered in the Dosage field. (The
associated cost is displayed to the right of the dosage.)
Note: CPRS now only auto-selects (highlights in
blue and places that entry in the field) a medication, dosage, route, or
schedule if the user types enough characters to uniquely identify an item in
the list. If the user does not enter enough characters to uniquely identify an
item, CPRS waits until the user manually selects an item using the mouse or the
keyboard.
- Enter a Route by either selecting one from
the list or typing in a valid route.
When the user selects a
regular schedule that does not have PRN, the administration times may display
in the Schedule column. The administration times will display if they have been
defined for the ward or if there is a default.
- If you selected an existing schedule, skip to step 13. If you
selected OTHER, CPRS displays the Order with Schedule ‘OTHER’ dialog. Take
the following steps:
a.
Select one or more
checkboxes by the appropriate days of the week.
b.
If the schedule
requires specific administration times skip to steps c and d. To select a
schedule from the list, highlight the schedule and select Add.
Note: Users can assign
either a schedule from the list or specific administration times, but not both.
If launched from the Complex tab, the Day-of-Week Schedule builder does not
display one-time schedules in the schedule list. Also, because the user is
specifying days of the week and a schedule, the list will contain only
schedules less than 24 hours (for example, Q36H will not be in the list).
c.
To use a specific
administration time, select the hour and minutes (if the user only selects the
hour, the minutes will default to zero) and select Add.
d.
Repeat step c until
you have entered all required administration times.
Warning: The administration times in the Schedule field apply to
each day of the week that is listed, such as TU-TH-SA@08002000, for example. To
create a schedule such as TU@0800 TH@2000, users would have to enter two
separate orders using the complex medication order dialog. Also, users may not
enter a schedule that only has administration times and PRN but no days.
e.
If you make a mistake
while selecting an administration time or schedule, do one of the following to
remove it:
o
For a single
administration time, highlight the hour and minutes in the Set Administration
Time fields and select Remove (so to remove 08:00, you would have to select
that time in the Set Administration Time fields not in the Schedule text box.)
o
To remove the
schedule, highlight the schedule and select Remove.
o
To remove the entire
schedule and begin again with step a, select Reset.
f.
Review the Schedule
field.
g.
When you have the
correct schedule, select OK.
The
Order with Schedule ‘OTHER’ dialog allows you to enter a customized day-of-week
and/or administration-time schedule. The user can enter specific administration
times or select a schedule from the available list
- If necessary, select PRN.
PRN will display in the
schedule field if the PRN checkbox is checked or if the schedule is defined in
the Pharmacy files as a PRN schedule.
- Select the Duration field and select the amount of time that the
patient should use the specified dose.
- In the then/and field, select the
appropriate conjunction for the order.
Note: The conjunction “Then” requires a duration to
be added.
- Select the next row in the Dosage field and
type or select a dosage.
The dosage may not begin with a decimal, for example .5; it
must begin with a numerical value, 0.5 for example. Also, the character “^” may
not be entered in the Dosage field. (The associated cost is displayed to the
right of the dosage.)
- CPRS fills in the Route and Schedule fields. You can change the
values in these fields if necessary.
- Select a duration and a conjunction (then
or and) except on the final row.
Note:
Your site’s IRM staff may have
specified rules governing the status of inpatient medication orders when
patients are transferred from one ward or service to another. It may have also
specified the number of days an inpatient medication order remains active.
Please check with your site’s IRM staff for information
about these rules.
- Repeat steps 15-18 until you have completed
the complex dose.
Note: You can also add or remove a row in the
complex dose. To add a row, click the
gray area in front of the row and click Add Row (CPRS places the new row above
the selected row). To delete a row, click the gray area in front of the row you
wish to delete and click Delete Row.
- Enter an Indication. If indications are defined, they
will display in the drop-down list for you to select or you may type in an
indication.
- Add comments (optional).
The date and time that the patient is scheduled to receive
the first dose of the medication appears under the Comments field. (For example, CPRS cannot show an expected first
dose for “on call” or schedules with PRN. On the complex tab, it will not try
to determine an expected first dose after a THEN because the first item must be
completed).
- If you want the patient to receive an additional dose now, select the
Give additional dose now check box. If you select the check box, the Give
Additional Dose Now for Complex Order warning dialog box appears, as shown
below.
This
graphic shows an example of the Give
Additional Dose Now for Complex Order warning when placing a complex order
When you select the Give
additional dose now check box, CPRS creates two new orders. Depending on
your version of CPRS, the order priority and dosing schedule may be set
automatically or may require manual adjustments. The pop-up messages displayed
will also vary.
The dosing schedule and priority are set automatically for
each order. The first order is scheduled for immediate administration (NOW) and
is assigned a priority of ASAP (or a site-specific alternative). The second
order is given the priority ROUTINE and follows the regular dosing schedule
that you defined when placing the order.
If you select a value for the Priority field before you select the Give additional dose now checkbox, a message notifies you that the
selected priority will be changed to the “Give additional dose now” priority
settings.
Note: If your site does not use the priority ASAP,
then an alternative priority (for example, STAT) will display in place of ASAP.
Warning
displayed when “Give additional dose now” is selected
- Check the orders and then select OK to close the warning dialog.
- Choose a priority from the Priority
drop-down list.
When Give additional
dose now is selected, the Priority
field is automatically set to ASAP (or a site-specific alternative). If you
select a value for the Priority
field before you select the Give
additional dose now checkbox, a message notifies you that the selected
priority will be changed to the “Give additional dose now” priority settings.
CPRS
displays a notification that “Give additional dose now” overrides any
previously selected priority
The default value of ASAP can be changed by selecting a
different value from the Priority
field before submitting the order.
- Select Accept Order.
Note: If you do not complete the mandatory items,
or if the information is incorrect, CPRS sends a message to tell you that the
information is incorrect and shows you the correct type of response.
d.
(Conditional) If the
medication ordered may be contraindicated because of allergies, drug
interactions, or duplicate orders, CPRS will display the Order Check window.
Carefully review all order checks and decide if the medication should be
ordered. Do one of the following:
● To proceed, select Accept
Order.
● To stop the ordering process and return to the dialog,
Cancel Order.
- Enter another medication order
-or-
select Quit.
When you select Quit, if the patient is in inpatient, CPRS
changes the patient’s location back to where the patient was before changing to
the clinic.
Note: You must sign the order before CPRS sends it
to the Pharmacy package. You can either sign the order now or wait until later.
When using Give additional dose now, it is recommended that you sign the order
immediately to send the order to the inpatient pharmacy. You only need to sign
once for both orders created when Give additional dose now is selected.
Note: If a provider has an NPI, it will not display
on the screen below.
On
the Orders tab, CPRS displays Clinic Medication orders under the Clinic
Medications display group, with the ordering location in the Location column
Changing Orders
Users can also change and renew Clinic Medication orders
from a clinic location. If the patient’s location is not a clinic location,
users will not be able to change or renew the Clinic Medication orders. To
change Clinic Medication orders, follow the instructions in the “Changing
Orders” section of this manual.
Clinic Infusions Overview
Clinic Infusions enable a CPRS user to place several
different kinds of infusion orders, including intravenous (IV), epidural, IV
piggyback, and so on, that are dispensed by inpatient pharmacy and administered
to an outpatient in a clinic setting. Clinic Infusions enable VistA order
checks to function for such medication orders.
Clinic Infusions orders must be placed
from a clinic location. When providers select the Clinic Infusions item under
the Write Order pane, CPRS will ask the providers to confirm that they are
placing a Clinic Infusions order. Either before or after the confirmation
dialog appears, providers must assign the encounter location to an appropriate
clinic. For outpatients, providers will be prompted if no encounter location
has been defined yet and then asked to confirm that they want to order Clinic
Medications. For inpatients, providers will be asked to confirm that they want
to order Clinic Medications first and then prompted for an appropriate clinic
location.
Other than being ordered from a clinic, the infusion
ordering process is almost identical to ordering infusions from any other
location. However, to be comprehensive, the steps for Clinic Infusions should
be complete in this section of the manual. As they are almost identical, the
information in this section is the same as much of the information under the
infusions ordering section.
Continuous versus Intermittent Infusion Orders
In the Infusion Order dialog, the order type—Continuous or
Intermittent— affects whether some fields are available or visible. The two
types of IVs are defined as follows:
●
Continuous IV: an IV
that runs at a specified rate (ml/hr, mcg/kg/min, etc.).
●
Intermittent IV: an IV
administered at scheduled intervals (Q4H, QDAY) or
One-Time only, “over a specified period of time” (e.g.,
“Infuse over 30 min.”).
For Intermittent orders, the Infusion Rate field changes to
be Infuse over Time, the
Schedule field becomes available (not greyed out), and
checkboxes display for the PRN and Give Additional Dose Now options. On both
dialogs, required fields are identified by an asterisk following the field
label (such as Route*, for example). Intermittent orders no longer require a
solution to finish the order. Continuous orders still require a solution before
the order can be finished. For CPRS to accept the order, the user must enter
values in the required fields, including the units.
For the Route field, CPRS uses the following rules to define
whether it displays a default route for the selected medication:
● If all of the orderable items on the order have the same
default medication route defined, CPRS designates the default medication route
in the selection list.
● If one or more orderable items on the order have different
default medication routes, no medication route in the selection lest will be
denoted as the default.
Placing Continuous Clinic Infusions Orders
Continuous infusion orders run at a specified rate. As the
user selects a solution and/or additive, the items from that list are displayed
to the right under Solution/Additive. For continuous infusion orders the only
optional fields are the Comments and the Duration or Total Volume fields. The
schedule field is not available.
The Additive Frequency field enables users to select which
IV bag the additive should be placed:
● Bag/Day: The additive should be put in one bag for 24
hours, normally the first bag.
● All Bags: The additive should be placed in all bags given
to the patient.
● See Comments: The provider wants something other than the
above options and will put appropriate instructions in the Comments box.
Note: If the user selects “See Comments” for the
Additive Frequency but does not enter appropriate instructions in the Comments
box, Pharmacy may interpret that as All Bags.
To order continuous
Clinic Infusions, use these steps:
- Select the Orders
tab.
- From the Write Orders pane, select Clinic Infusions.
Note: Depending
on how menus are set up at your site, you may need to select a different option
from the Write Orders pane. Many sites have customized the items in the Write
Orders pane. Check with your CAC (or the person who manages information
resources at your site) if you have trouble locating the Clinic Infusions
item.
Note: The following prompts will be slightly
different based on the patient’s location. You will be asked to verify that you
want to write Clinic Infusions and to ensure that the encounter location is a
clinic location.
- If prompted, enter
the appropriate clinic for the encounter information. This will generally
happen with an outpatient that does not yet have an encounter defined.
You can use an existing appointment if one exists or create
a new one. To use Clinic Infusions, you must enter a location that was
previously defined clinic. If you chose a clinic location, you will see this
dialog.
This
dialog is to ensure that the user knows they are about to enter Clinic
Infusions
- To continue ordering Clinic Medications, select Yes and continue to
the next step. To stop the Clinic Medications process, choose No.
- (Conditional) If the patient’s current
location is not a clinic, change the patient’s location to the appropriate
clinic.
The Clinic Infusion Order dialog
displays.
The Infusion Order dialog for
continuous infusion orders does not use a schedule, but it does have an
infusion rate. For continuous infusion orders, the new Additive Frequency field
enables providers to indicate into which IV bag the additive should be placed
- Select the needed solutions from the Solutions tab.
- Select an additive from the list (if necessary) and edit the
strength if needed. Repeat for
additional additives if necessary. How users can edit the strength field
will depend on the values for strength defined in the pharmacy files as
follows:
● If a single strength is defined, users cannot edit the
field.
● If multiple values for strength are defined in the pharmacy
files, the field will have a drop-down list from which users can choose a
strength.
● If no values have been defined, users can type in a
strength. If a strength includes a decimal point, the value must begin with a
number: so, .5 is not valid, but 0.5 is.
The solution and additives you
select will appear in the Solution/Additive grid.
Note: To remove
an additive or a solution, select the solution or additive and select Remove.
- Enter a volume and strength in the Solution/Additive grid (if
necessary).
- Select the Additive Frequency from the list:
● 1 Bag/Day: The additive should be put in one bag for 24 hours,
normally the first bag.
● All Bags: The additive should be placed in all bags given to the
patient.
● See Comments: The provider wants something other than the above options.
Enter the appropriate instructions in the Comments box.
- Select a Route (such as intravenous, epidural, IV piggyback, etc.)
If the desired route is not available, select the Other option in the list
of routes to bring the expanded med route form that lists all possible IV
routes.
- In the Type field, select Continuous.
Note: If you change the IV Type from Continuous to
Intermittent, the Schedule field becomes available and the Infusion Rate field
becomes the Infusion over Time field.
Note: For a definition of Continuous and
Intermittent orders, select the IV Type Help link and a message box will
display with a short definition of what the terms mean.
To
help providers enter the correct type of infusion order, this dialog provides a
definition of Continuous and Intermittent infusion orders
- Enter an infusion rate in ml/hr.
- Select a Priority.
- (Optional) Enter a number for the duration or total volume of
fluids for this order.
- Select the
appropriate unit (liters-L, milliliters-ml, days, or hours).
Note: If you change the units, the value in the
Duration or the Total Volume field will be removed and you will need to enter
it again. This is a safety feature to ensure the patient does not receive a
dangerous amount of fluid.
- Enter an Indication for the medication. If they have
been entered, you can use the drop-down list and select the indication or
you can type an indication in the field.
- Enter any comments (if necessary).
- Review the order text at the bottom of the dialog to ensure that it
is correct.
- Select Accept Order.
- Review order check items and respond appropriately. If the order
should not be entered because of a possible interaction, select Cancel. If
the order is okay to accept, select Accept Order.
- To enter additional Clinic Infusion orders,
repeat steps 6-19 as needed. To finish, select Quit. For an outpatient,
when you select quit, the encounter location will remain with the current
clinic. For an inpatient, when you select Quit, the encounter location
will go back to the location where the patient was before you began
entering Clinic Infusion orders.
Note: The order must be signed before it is sent.
You can either sign the order now or wait until later.
Placing Intermittent Clinic Infusion Orders
Intermittent Clinic Infusion orders have many of the same
required fields as continuous orders, but there are some important differences.
Of course, to order these infusions, the patient must be assigned a clinic
location. Intermittent refers to an infusion order administered at scheduled
intervals (Q4H, QDAY) or One-Time only, “over a specified period of time”
(e.g., “Infuse over 30 min.”). For intermittent infusion orders, as the user
selects a solution and/or additive, the items from that list are displayed to
the right under Solution/Additive. For Intermittent infusion orders the only
optional fields are the Comments, Infuse Over, and the Duration or Total Volume
fields.
However, for intermittent orders, the Infusion Rate field
changes to the Infuse Over Time field where the user enters either a number of
minutes or hours. the schedule field is not available.
To order intermittent
Clinic Infusion orders, follow these steps:
- Select the Orders tab.
- From the Write Orders pane, select Clinic Infusions.
Note: Depending
on how menus are set up at your particular site, you may need to select a
different option from the Write Orders pane. Many sites have customized the
items in the Write Orders pane. Check with your CAC (or the person who manages
information resources at your site) if you have trouble locating the Clinic
Infusions item.
Note: The following prompts will be slightly
different based on the patient’s location. You will be asked to verify that you
want to write Clinic Infusions and to ensure that the encounter location is a
clinic location.
- If prompted, enter the appropriate clinic
for the encounter information. This will generally happen with an
outpatient that does not yet have an encounter defined.
You can use an existing appointment if one exists or create
a new one. To use Clinic Infusions, you must enter a location that was
previously defined clinic. If you chose a clinic location, you will see this
dialog.
This
dialog is to ensure that the user knows they are about to enter Clinic
Infusions
- To continue ordering Clinic Medications, select Yes and continue to
the next step. To stop the Clinic Medications process, choose No.
- (Conditional) If the patient’s current
location is not a clinic, change the patient’s location to the appropriate
clinic.
The Clinic Infusion Order dialog
displays.
The Infusion Order dialog for continuous
infusion orders does not use a schedule, but it does have an infusion rate. For
continuous infusion orders, the new Additive Frequency field enables providers
to indicate into which IV bag the additive should be placed
- Select a solution from the Solutions tab.
- Select an additive from the list (if
necessary) and edit the Volume/Strength.
Repeat for additional additives if necessary.
The solution and additives you
select will appear in the Solution/Additive grid.
Note: To remove an additive or a solution, select
the solution or additive and click Remove.
- Select the Route (for example, intravenous, epidural,
IV piggyback, etc.) from the drop-down list. If the desired route is not
available select the Other option in the list of routes to bring the
expanded med route form that list all possible IV routes.
- In the Type drop-down box, select Intermittent.
Note: If you change the IV Type from Intermittent
to Continuous, the Schedule field becomes unavailable (greyed out) and the
Infusion over Time field becomes the Infusion Rate field.
Note: For a definition of Continuous and
Intermittent orders, select the IV Type Help link and a message box will
display with a short definition of what the terms mean.
To
help providers enter the correct type of infusion order, this dialog provides a
definition of Continuous and Intermittent infusion orders
- Select a schedule from the list or create
one using the Day-of-Week schedule builder.
Note: When a user writes an intermittent infusion
order with a schedule of ONCE, the following will happen in CPRS:
● The DURATION field will be disabled.
● The Give Additional Dose Now option will be disabled.
● Expected First Dose and Administration Times will not be
displayed.
Note: When a user writes an intermittent
infusion order with a schedule of On Call or a PRN, the following will happen
in CPRS:
● Expected First Dose and Administration Times will not be
displayed.
- If you selected an existing schedule, skip to step 14. If you
selected OTHER, CPRS displays the Order with Schedule ‘OTHER’ dialog. Take
the following steps:
a.
Select one or more
checkboxes by the appropriate days of the week.
b.
If the schedule
requires specific administration times skip to steps c and d. To select a
schedule from the list, highlight the schedule and select Add.
Note: Users can assign either a schedule from the list or specific
administration times, but not both.
c.
To use a specific
administration time, select the hour and minutes (if the user only selects the
hour, the minutes will default to zero) and select Add.
d.
Repeat step c until
you have entered all required administration times.
Warning: The administration times in
the Schedule field apply to each day of the week that is listed, such as
TU-TH-SA@08002000, for example. To create a schedule such as TU@0800 TH@2000,
users would have to enter two separate orders using the complex medication
order dialog. Also, users may not enter a schedule that only has administration
times and PRN but no days.
e.
If you make a mistake
while selecting an administration time or schedule, do one of the following to
remove it:
o
For a single
administration time, highlight the hour and minutes in the Set Administration
Time fields and select Remove (so to
remove 08:00, you would have to select that time in the Set Administration Time
fields not in the Schedule text box.)
o
To remove the
schedule, highlight the schedule and select Remove.
o
To remove the entire
schedule and begin again with step a, select Reset.
f.
Review the Schedule
field.
g.
When you have the
correct schedule, select OK.
- If necessary, select the PRN checkbox.
- Enter the number for the duration over which to infuse the
medication.
- Move to the next field and select the unit
of time (the units can be only Minutes or Hours) over which the infusion
should be given.
For example, you might enter 30 for the number, move to the
next field, and then select minutes to define infuse over 30 minutes.
- Select the Priority.
- Enter a number for the duration or total volume.
- Move to the next field and select the
appropriate unit (liters-L, milliliters-ml, days, hours, or doses).
Note: If you change the units, the value in the
Duration or the Total Volume field will be removed and you will need to enter
it again. This is a safety feature to ensure the patient does not receive a
dangerous amount of fluid.
- If necessary, select the Give additional
dose now checkbox.
Note: Make sure that you are careful about using
give additional-dose-now functionality. When you click the check box, CPRS
creates two new orders and sends it to Inpatient Medications. Make sure the
“Give additional dose now” and the regular order with the original schedule you
entered do not overmedicate the patient. “Give additional dose now” is not
available for ONCE, ONE-TIME, or NOW orders. It is also not available for
delayed orders.
- Enter an Indication. If they have been entered, you
can use the drop-down list and select the indication or you can type an
indication in the field.
- Enter any comments (if necessary).
- Review the order text at the bottom of the dialog to ensure that it
is correct.
- If the order text is correct, select Accept Order.
- Review order check items and respond
appropriately. If the order should not be entered because of a possible
interaction, select Cancel. If the order is okay to accept, select Accept
Order.
- To enter additional Clinic Infusion orders,
repeat steps 6-19 as needed. To finish, select Quit. For an outpatient,
when you select quit, the encounter location will remain with the current
clinic. For an inpatient, when you select Quit, the encounter location
will go back to the location where the patient was before you began
entering Clinic Infusion orders.
Note: The order must be signed before it is sent.
You can either sign the order now or wait until later.
One Step Clinic Medication Administration
One Step Clinic Administration enables providers to access,
order, and document that they administered Clinic Medications in a single
process. One Step Clinic Admin bypasses the pharmacy for verification (comes
over as ‘done’) and automatically records the clinician administered medication
details in the BCMA patient medication log file.
To use One Step
Clinic Admin for Unit Dose medications, please use the following steps:
Note: One-Step
Clinic Medication Administration is only used when the doctor will PERSONALLY
administer a medication in a clinic setting. If a nurse will administer the
medication, use Clinic Medications or other ordering method.
- Select One
Step Clinic Admin. (This can be done from the Orders tab Write Orders
pane, if an option is available, the Orders tab Action menu, the Meds tab
Action menu, or from a progress note).
Note: If the provider has an NPI, it will display
on the screen below. See the
"National Provider Identifier (NPI) Display in CPRS" section for an
example of an NPI displaying on a screen.
The Order Manager dialog displays as shown below.
- If necessary, select
an appropriate clinic encounter location and time.
- If necessary, select the Unit Dose radio
button.
- If necessary, designate the injection site
using the Injection Site drop-down box to locate and select the site
(i.e., ARM, LEFT UPPER or THIGH, LEFT).
- Enter the Action Date/Time for the
administration (you can use T for today, N for now, or enter a specific
date and time, such as DEC 10, 2014@13:10).
- Place your cursor in the Scan Medication
Bar Code field (the colored rectangle in front of the field will turn from
red to green indicating that it is ready to receive data) and scan the
medication,
-or-
To manually enter the medication,
place your cursor in the Scan Medication Bar Code field (the colored rectangle
in front of the field will turn from red to green indicating that it is ready
to receive data) and type part or the entire medication name and press
<Enter>.
- In the Multiple Drugs for Selected Order
dialog, select the appropriate drug by either clicking on the drug name or
using the up and down arrow buttons to highlight the name and pressing
<OK>.
- Select the Order button.
In the Clinic
Medications dialog that displays, do the following:
a.
Enter a dosage, either
picking from the list or typing a dosage in.
b.
Select a route.
c.
Select a schedule (Now
or Stat).
d.
(Optional) Enter a
comment.
e.
If the information is
correct, select the Accept Order button. If the information is not correct,
correct it or select the Quit button to cancel the order.
Note: If you select Quit, the information is
removed and a dialog displays the message that the order was canceled. Select
OK. You are then returned to the Order Manager dialog as if you are just
beginning the process.
- If any order checks display, review and act
on them appropriately.
- If all is correct, select the Review/Sign
button.
- In the Review /Sign Changes dialog, enter
your electronic signature and select OK.
- If another order dialog displays, review
and take appropriate action, either accepting the order or canceling the
order.
The order displays under the Orders Tab in CPRS. You may
need to change the view to see the order. If you do not see the order under the
Clinic Medications or Clinic Infusions headings, please use the View | Custom
View menu option in CPRS and selected Completed/Expired option for Pharmacy.
The items should display there.
To use One Step
Clinic Admin for IV medications, please use the following steps:
Note: One-Step
Clinic Medication Administration is only used when the doctor will PERSONALLY
administer a medication in a clinic setting. If a nurse will administer the
medication, use Clinic Medications or other ordering method.
- Select One Step Clinic Admin. (This can
be done from the Orders tab Write Orders pane, if an option is available,
the Orders tab Action menu, the Meds tab Action menu, or from a progress
note).
- If necessary, select an appropriate clinic
appointment or clinic and time for the encounter.
- Select the IV radio button.
- Select the IV type from the drop-down box:
Admixture, Piggyback, or Syringe.
Depending on which IV type you
choose, you will need to make selections under the IV’s section. Selecting
Admixture does not affect the other fields, but selecting Piggyback will
activate the Schedule field and selecting Syringe will active the Intermittent
Syringe field.
- If you selected Piggyback, you must select
a schedule of either NOW or STAT.
- If you selected Syringe, you must designate
whether this is an Intermittent Syringe by choosing YES or NO from the
Int. Syringe drop-down.
- Select an injection site from the drop-down
list.
- Enter a date and time when the medication
was administered.
You can use N for Now, T for
today, or you can set a specific date and time, such as 12/11/2014@13:35 (for
December 11, 2014 at 1:35 p.m.).
- Enter the medication and the solution, if
necessary. Place your cursor in the Scan Medication Bar Code field (the
colored rectangle in front of the field will turn from red to green
indicating that it is ready to receive data) and scan the medication,
-or-
To manually enter the medication,
place your cursor in the Scan Medication Bar Code field (the colored rectangle
in front of the field will turn from red to green indicating that it is ready
to receive data) and type part or the entire medication name and press
<Enter>.
- In the Multiple Drugs for Selected Order dialog,
select the appropriate drug by either clicking on the drug name or using
the up and down arrow buttons to highlight the name and pressing
<OK>.
- Repeat this step for the solution or
medication if necessary.
This
screen capture shows the Multiple Drugs for Selected Order dialog that displays
if a user is manually entering a medication instead of scanning it
- Select the Order button.
- Enter the additional information for the IV
type you chose below:
●
Admixture: In the
Clinic Infusion Orders dialog, enter the Volume/Strength, Route, Infusion Rate,
and a comment (optional) and select Accept Order.
●
Piggyback: In the
Clinic Infusion Orders dialog, enter the Volume/Strength, Route, Schedule (NOW
or STAT). Optionally you can enter a comment (optional) and designate over what
period of time the IV should be administered. Then, select Accept Order.
●
Syringe: In the Clinic
Infusion Orders dialog, enter the Volume/Strength, Route, Infusion Rate, and a
comment (optional) and select Accept Order.
- If any order checks display, review and act
on them appropriately If you have more IV medications to order, repeat
steps 3-12 until all medications have been ordered.
- When ready, select the Review/Sign button.
- Review the orders to be signed.
- If the orders are correct, enter your
electronic signature and select the OK button.
- If another order dialog displays, review
and take appropriate action, either accepting the order or canceling the
order.
The order displays under the Orders Tab
in CPRS. You may need to change the view to see the order. If you do not see
the order under the Clinic Medications or Clinic Infusions headings, please use
the View | Custom View menu option in CPRS and selected Completed/Expired
option for Pharmacy. The items should display there.
Ordering Outpatient Medications (Simple Dose)
For outpatient medications, the user must enter the required
fields. CPRS requires the users to enter the medication, dosage, route, and
schedule. For outpatient medications, dosage, schedule, and route can be
free-text entries, but the medication must be chosen from the list of options.
The route can be typed in, but to be accepted, it must be a valid route that is
in the MEDICATION ROUTES file #51.2.
Also, medications that are not in the formulary display in
the list with the letters “NF” after the name or synonym, which is also
displayed. CPRS checks for nonformulary dosages (e.g., the VA formulary may not
have a 2.5 MG pill, but it may have a 5.0 MG pill) and for non-formulary
orderable items (e.g., the VA may not carry a specific kind of allergy
medication).
To write a new outpatient medication order with a simple
dose, follow these steps:
1. Select the Meds tab and select Action
| New Medication…
-or- select the Orders tab and click the
appropriate item under the Write Orders list.
The Outpatient Medications dialog
appears (as shown in the graphic below).
The Outpatient Medications order
dialog
Note: If encounter
information has not been entered, the encounter information dialog will appear
before the Medication Order dialog box. You must complete the encounter
information dialog box before proceeding.
Note: If the selected
medication is a controlled substance that requires the signature of a provider
with a DEA number, the Order not
completed dialog appears. Before an order for a controlled substance can be
entered, the provider selected for the encounter must be able to sign the
order. You may need to exit the Medication Order dialog, change the provider,
and reenter the Medication Order dialog.
You must have a DEA# to order
certain medications
Note: CPRS requires a
patient have a valid address if the selected outpatient medication is a
controlled substance that requires the signature of a provider with a DEA
number. For outpatient controlled substances, CPRS displays a message –
“Controlled substance prescriptions require a patient address. Please contact
administrative support to update patient address information.” if the patient
does not have a valid address. The contact information in the display may be
customized using the Enter/Edit Missing ZIP Code Message option in the GUI
Parameters menu.
Controlled substance prescriptions
require a patient address
Note:
Provider must have YSCL AUTHORIZED to order clozapine. Currently, CPRS
will allow a provider without authorization key to place clozapine order. For
example, if PROVIDER, TWO is logged in, they do not have the YSCL AUTHORIZED
key, change the encounter provider to PROVIDER, ONE (they do have the key),
then place the Clozapine order, it shows up on Orders screen, then sign the
order using PROVIDER, TWO. Now the signed order shows PROVIDER, TWO and it is
Pending the pharmacist is able to complete the order, making it Active. **Even
though CPRS allows the order to go through, this action should not be done.
2.
In the Medication
Order dialog, locate the medication name or quick order name in the list box by
typing characters in the Medication field.
Note: CPRS now only
auto-selects (highlights in blue and places that entry in the field) a
medication, dosage, route, or schedule if the user types enough characters to
uniquely identify an item in the list. If the user does not enter enough
characters to uniquely identify an item, CPRS waits until the user manually
selects an item using the mouse or the keyboard.
3.
Select the quick order
or medication name using the mouse or keyboard.
The lab results for the most recent
lab test associated with the selected medication are displayed in the
Information field, if an associated lab test was performed within the last 365
days.
Note: A CAC or ADPAC will
need to set the OR CPRS LAB DISPLAY ENABLED parameter to ON to activate the lab
results display at a site.
To view associated lab results for
Quick Orders, a TIU OBJECT must be inserted into the Quick Order. For more
information, refer to the Text
Integration Utility (TIU) Clinical Coordinator & User Manual. This
functionality will work for generalized Quick Orders only (orders assigned to
Order Menus). It is not currently implemented for personal Quick Orders.
The lab results functionality will
not work properly for multidivisional facilities or any sites that use
different lab test names at different sites, as only one lab test name can be
associated with each drug. To successfully implement this functionality, all
facilities/divisions that share a VistA system must use the same name for each
monitored lab test.
4.
Select the
dosage.
The dosage may not begin with a
decimal, for example .5; it must begin with a numerical value, 0.5 for example.
Also, the character “^” may not be entered in the Dosage field. (The associated
cost is displayed to the right of the dosage.)
Note: CPRS now only
auto-selects (highlights in blue and places that entry in the field) a
medication, dosage, route, or schedule if the user types enough characters to
uniquely identify an item in the list. If the user does not enter enough
characters to uniquely identify an item, CPRS waits until the user manually
selects an item using the mouse or the keyboard.
Once a dosage is selected, any lab test
results displayed in the Information field are replaced by the National
Standard Orderable Item information.
The tier level represents
medication copayment classes for Outpatient Pharmacy charges that are dependent
on the medication class. It is used to
determine the charge rate for copayments.
5.
Enter a Route by either selecting one from the
list or typing in a valid route.
Note: Outpatient
orders for supply items do not require a route.
6.
Choose a schedule from
the Schedule field. (Select PRN, if desired.)
7.
CPRS completes the
default days supply field and calculates the quantity field based on the
formula days supply x schedule = quantity. If necessary, highlight and change
the numbers in these fields.
Note: If you change a
number, CPRS will attempt to recalculate the other field. If you check PRN, be sure that the quantity
field is correct before accepting the order.
8.
Enter the number of
refills.
9.
Select the location
where the patient should pick up the medication from the Pick Up field.
10.
Choose a priority.
11.
Enter an Indication.
If they have been entered, you can use the drop-down list and select the
indication or you can type an indication in the field.
12.
Add comments in the
Comments field (if desired).
13.
Under certain
circumstances, a check box may appear under the Days Supply field. If the
medication is service-connected, make sure the box is checked
14.
Select Accept Order.
15.
(Conditional) If the
medication ordered may be contraindicated because of allergies, drug
interactions, or duplicate orders, CPRS will display the Order Check window.
Carefully review all order checks and decide if the medication should be
ordered. Do one of the following:
o
To proceed, select
Accept Order.
o
To stop the ordering
process and return to the dialog, Cancel Order.
16.
If you are finished
ordering outpatient medications, select Quit.
Note: The order must be
signed before it is sent to the Pharmacy package. You can either sign the order
now or wait until later.
Ordering Outpatient
Medications (Complex Dose)
Users must enter a medication name, dosage, route, and
schedule. For outpatient medications, dosage, schedule, and route can be
free-text entries, but the medication must be chosen from the list of options.)
The route can be typed in, but to be accepted, it must be a valid route that is
in the MEDICATION ROUTES file #51.2.
In a complex dose order, the user must define specific
characteristics for the order. Because the dose can affect the quantity, for
example, changing certain fields may cause the quantity field to either
recalculate or reset to zero to force the user to enter the quantity.
To write a new Outpatient Medication order with a complex
dose, follow these steps:
1.
Select the Meds tab
and select Action | New Medication…
-or-
2.
Select the Orders tab
and select the appropriate item under the Write Orders likst box. CPRS will
display the Medication Order dialog.
Note: If encounter information has not been entered, the encounter
information dialog will appear before the Medication Order dialog. You must
complete the encounter information dialog before proceeding.
3.
In the Medication
Order dialog, locate the medication name or quick order name in the list box by
typing characters in the Medication field.
Note: CPRS now only
auto-selects (highlights in blue and places that entry in the field) a
medication, dosage, route, or schedule if the user types enough characters to
uniquely identify an item in the list. If the user does not enter enough
characters to uniquely identify an item, CPRS waits until the user manually
selects an item using the mouse or the keyboard.
4.
Select the quick order
or medication name using the mouse or keyboard.
Once the name is selected, CPRS
displays a second dialog to select the items for the rest of the order. In the
top field of the second dialog, the generic medication name and the synonym
(usually a brand name) are displayed.
The lab results for the most recent
lab test associated with the selected medication are displayed in the
Information field, if an associated lab test was performed within the last 365
days.
Note: A CAC or ADPAC will
need to set the OR CPRS LAB DISPLAY ENABLED parameter to ON to activate the lab
results display at a site.
To view associated lab results for
Quick Orders, a TIU OBJECT must be inserted into the Quick Order. For more
information, refer to the Text
Integration Utility (TIU) Clinical Coordinator & User Manual. This
functionality will work for generalized Quick Orders only (orders assigned to
Order Menus). It is not currently implemented for personal Quick Orders.
The lab results functionality will
not work properly for multi-divisional facilities or any sites that use
different lab test names at different sites, as only one lab test name can be
associated with each drug. To successfully implement this functionality, all
facilities/divisions that share a VistA system must use the same name for each
monitored lab test.
Note: If the selected medication is a controlled
substance that requires the signature of a provider with a DEA, the Order not completed dialog will appear.
Before an order for a controlled substance can be entered, the provider
selected for the encounter must be able to sign the order. You may need to exit
the Medication Order dialog, change the provider, and then reenter the
Medication Order dialog.
You must have a DEA# to order
certain medications
Note: CPRS
requires a patient to have a valid address if the selected outpatient
medication is a controlled substance that requires the signature of a provider
with a DEA number. For outpatient controlled substances, CPRS displays a
message – “Controlled substance prescriptions require a patient address. Please
contact administrative support to update patient address information.” if the
patient does not have a valid address. The contact information in the display
may be customized using the Enter/Edit Missing ZIP Code Message option in the
GUI Parameters menu.
Controlled
substance prescriptions require a patient address
5.
Click the Complex dose tab.
Note: Once you begin a
complex medication order, you must remain on the Complex tab until you finish
the order. If you switch tabs, all complex dosages will be erased, and you will
be forced to start the order again.
You can enter a complex medication
order from the Medication Order dialog
6.
Click the Dosage field and select the appropriate
dosage.
The dosage
may not begin with a decimal, for example .5; it must begin with a numerical
value, 0.5 for example. (The associated cost is displayed to the right of the
dosage.)
Note: CPRS now only
auto-selects (highlights in blue and places that entry in the field) a
medication, dosage, route, or schedule if the user types enough characters to
uniquely identify an item in the list. If the user does not enter enough
characters to uniquely identify an item, CPRS waits until the user manually
selects an item using the mouse or the keyboard.
Once a dosage is selected, any lab
test results displayed in the Information field are replaced by the National
Standard Orderable Item information.
7.
Enter a Route by either selecting one from the
list or typing in a valid route.
Note: Outpatient orders for
supply items do not require a route.
8.
Enter a schedule in
the Schedule field. (Select PRN if desired).
9.
Select the Duration
cell and enter a number and select units (days is the default) a patient should
use the specified dose.
10.
Enter the appropriate
conjunction in the then or and field except on the final row.
Note: The conjunction
“Then” requires a duration to be added.
11.
Select the Dosage field in the next row and select
a dosage.
The dosage may not begin with a
decimal, for example .5; it must begin with a numerical value, 0.5 for example.
Also, the character “^” may not be entered in the Dosage field. (The associated
cost is displayed to the right of the dosage.)
12.
Repeat steps 5-9 until
you have completed the complex dose.
Note: You can add or remove
a row in the complex dosage. To add a row, click the gray area in front of the
row and click Add Row. (The new row will be placed above the selected row.) To
delete a row, click the gray area in front of the row to be deleted and click
Delete Row.
13.
CPRS will display a
default value in the Days Supply and Quantity fields. The quantity is
calculated based on the formula Days Supply x Schedule = Quantity. If
necessary, you can change the value in these fields.
Note: If you change a
number, CPRS will attempt to recalculate the other field.
14.
Enter the number of
refills.
15.
Select the location
where the patient should pick up the medication from the Pick Up field.
16.
Enter an Indication.
If they have been entered, you can use the drop-down list and select the
indication or you can type an indication in the field.
17.
Add comments if
necessary.
18.
Under certain
circumstances, a check box may appear under the Days Supply field. If the
medication is service-connected, make sure the box is checked.
19.
Select Accept Order.
20.
(Conditional) If the
medication ordered may be contraindicated because of allergies, drug
interactions, or duplicate orders, CPRS will display the Order Check window.
Carefully review all order checks and decide if the medication should be
ordered. Do one of the following:
o
To proceed, select
Accept Order.
o
To stop the ordering
process and return to the dialog, Cancel Order.
21.
If you are finished
ordering outpatient medications, select Quit.
Note: The
order must be signed before it is sent. You can either sign the order now or
wait until later.
Adding Non-VA Medications
The Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) has indicated that all medications, including herbal
supplements, over-the-counter (OTC) non-prescription medications, and
medications prescribed by providers outside the VA (collectively known as
“Non-VA medications”) should be entered in the medical record. CPRS, Outpatient
Pharmacy, and Inpatient Medications developers have made changes that enable
users to enter this information into the medical record so that providers have
a better picture of the medications the patient is taking and that order checks
against these medications can occur. Entering Non-VA Medications will trigger
the following order checks:
● Duplicate Drug (shows as Duplicate Order check)
● Duplicate Drug Class
● Critical Drug Interaction
● Significant Drug Interaction
● Allergy checks
Note: For Non-VA meds, inpatient orders are not checked
against nonVA medications and the allergy check is slightly different. The
duplicate drug class check will not be triggered for two pure herbal
medications, such as ginger and gingko. All pure herbal medications belong to
the same drug class (HA000). If these checks were made, every time a clinician
entered a pure herbal medication, the user would receive a duplicate drug class
warning. Allergy checks will still occur for non-VA medications that do not
belong to this drug class.
Making Non-VA Meds Available for Entry
For users to be able to enter these medications through
CPRS, they must be in the CPRS Orderable Items file so that they appear when
the user chooses the new order sheet. The Pharmacy patch (PSS*1.0*68) enables
sites to mark items as Non-VA Medications. Initially, all Pharmacy orderable
items that are marked as “outpatient” and are not supply items will be
automatically made Non-VA medications. Subsequently, Pharmacy coordinators can
use the Pharmacy option Drug Enter/Edit [PSS DRUG ENTER/EDIT] to identify items
as Non-VA Meds or remove the designation.
Note: For more information about how to get Non-VA
Medications added to the appropriate file, please see “Section 5.1:
Communicating New Non-VA Meds Entries to the Pharmacist” in the Herbal/OTC/Non-VA Meds Documentation
Release Notes that will be located on the VistA Documentation Library at http://www.va.gov/vdl under the Outpatient
Pharmacy listings.
Different from Ordering Medications
Remember that entering Non-VA Medications is not the same as
placing orders. Users simply enter information to provide a more complete view
of what the patient is taking. However, once the items are available in the
CPRS Orderable Items file, the process for entering Non-VA Medications is
similar to entering other orders, but there are a few differences:
● Almost any CPRS user can enter Non-VA medication
information. However, sites can restrict access for those holding the OREMAS
key by using the OR OREMAS NON-VA MEDS parameter. For more information about
this parameter, please see the CPRS Technical Manual: GUI Version.
● Users can enter Non-VA medication even if they only have
partial information. The only required information is the non-VA or herbal
medication name. The Medication name must be one that can be selected from the
list. The Dosage, Route, and Schedule fields are optional and will accept
free-text entries.
● Non-VA medications are listed separately on the orders tab
and the designation “Non-VA Med” is displayed at the beginning of the entry.
● Users may to pick a reason why the patient is taking the
Non-VA medication.
For the reason/statement that users should enter, developers
sent out four reasons or
statements at the package level of the parameter GUI Non-VA
Med Statements/Reasons that were agreed upon by a workgroup:
● Non-VA medication not recommended by VA provider.
● Non-VA medication recommended by VA provider.
● Patient wants to buy from Non-VA pharmacy.
● Medication prescribed by Non-VA provider.
Authorized users can enter their own reasons/statements in
the parameter by entering new statements at the System or Division level for
this parameter. For more information about changing this parameter, see the CPRS Technical Manual: List Manager.
Documenting Non-VA Medication
Information for Simple Doses
Previously, the designation “Non-VA Meds” caused some
confusion as to whether providers were ordering or documenting outside
medication. Therefore, throughout CPRS the name has been changed to “Non-VA
Medications (Documentation)” or “Non-VA Meds (Documentation)”. When the user
selects the Non-VA Medications (Documentation) option, the dialog displays the
items that were marked as Non-VA Meds and copied into the CPRS Orderable Items
file.
To enter Non-VA medication information, use the following
steps:
1.
If you are not already
there, go to the Orders tab by either clicking Orders or pressing Ctrl + O.
2.
In the Write Orders
list, select Meds, Non-VA.
Note: If encounter information has not been entered,
the encounter information dialog will appear before the Medication Order
dialog. You must complete the encounter information dialog before
proceeding.
3.
In the Document
Herbal/OTC/Non-VA Medications dialog, select the medication or herbal
supplement by
a.
Typing a few letters
of the name or its synonym (if your site uses synonyms).
Note: CPRS now only
auto-selects (highlights in blue and places that entry in the field) a
medication, dosage, route, or schedule if the user types enough characters to
uniquely identify an item in the list. If the user does not enter enough
characters to uniquely identify an item, CPRS waits until the user manually
selects an item using the mouse or the keyboard.
b.
Selecting the correct
name from the list by double-clicking it or highlighting it and pressing
<Enter>. You may need to scroll down to find the name.
Note: If you do not
know other information such as dosage, route, or schedule, you may enter only
the name of the medication or herbal supplement.
4.
Enter a dosage (if
known).
The dosage may not begin with a
decimal, for example .5; it must begin with a numerical value, 0.5 for example.
(The associated cost is displayed to the right of the dosage.)
5.
Enter a route (if
known).
6.
Enter a schedule,
including PRN if necessary (if known).
7.
(Optional) Enter an
Indication. If they have been entered, you can use the drop-down list and
select the indication or you can type an indication in the field.
8.
Enter any
comments.
9.
If you want to enter
one, select one or more Statements/Explanations as to why the patient is taking
the medication or supplement.
10.
Enter a start date (if
known).
11.
Review the information
entered in the text box at the bottom of the dialog.
12.
Place the information
into the patient’s record by clicking Accept
Order or by tabbing to Accept Order
and pressing <Enter>.
13.
(Conditional) If the
medication ordered may be contraindicated because of allergies, drug
interactions, or duplicate orders, CPRS will display the Order Check window.
Carefully review all order checks and decide if the medication should be
ordered. Do one of the following:
o
To proceed, select
Accept Order.
o
To stop the ordering
process and return to the dialog, Cancel Order.
14.
To enter additional
Non-VA Medications into the patient’s record, repeat steps 3-12.
15.
When you are through
entering Non-VA medications, exit the dialog using the Quit button.
Note: Non-VA Meds do not
require an electronic signature, but they will be presented at the end of the
current CPRS session on the Sign screen. You can do the normal signing process
or if you only have Non-VA meds, you might get OK and Cancel buttons on a
dialog instead of the normal Sign screen. You cannot click on the checkbox in
front of a Non-VA Med to deselect and not approve it. Non-VA Meds because they
do not require electronic signature will be automatically entered when you
click OK or enter your electronic signature.
Documenting Non-VA Medication
Information for Complex Doses
When you start documenting non-VA medication information for
a complex dose, you need to remain on the Complex tab until you click the
Accept Order button. If you switch to
the Dosage tab, all complex dosages will be erased.
To document Non-VA medication information for a complex
dose, use the following steps:
- From the Orders tab, select Non-VA Meds in
the Write Orders table.
Note: If encounter
information has not been entered, the encounter information dialog will appear.
You must complete the encounter information dialog before proceeding.
- In the Document Herbal/OTC/Non-VA Medications dialog, select the
medication or herbal supplement from the dropdown. If you enter a few characters in the
Name field, you will immediately see a list of names in the dropdown that
contain those characters.
- Select the Complex tab.
- Enter the appropriate dosage in the Dosage
field.
Note: The dosage must begin with a numerical value (for example,
0.5). The dosage cannot begin with a
decimal (for example, .5) and the “^”
character is not allowed.
- Enter
a Route by either selecting a value from the dropdown or entering a value.
- Select
a value from the Schedule dropdown. Check the PRN checkbox, if necessary.
- In
the Duration field, enter a numeric value and select the units a patient
should use for the specified dose (day is the default).
- In the add/then dropdown, select a
direction and a conjunction (no conjunction on the final line).
Note: If you select the “then” conjunction, you are required to add
a duration.
- In the next row, enter a dosage in the Dosage field.
- If necessary, change the values in the Route and Schedule fields.
- In the add/then dropdown, enter a duration and a conjunction (no
conjunction on the final line).
- Repeat steps 4 through 11 until you have
completed the complex dose.
Note: To add a row, click on
the area where you want to place the new row and then, click on the Insert Row
button. To remove a row, click on the row to be deleted and then, click on the
Remove Row button.
- Enter an Indication (optional). If indications are defined, they
will display in the drop-down list or you may type in an indication.
- Add a comment (optional).
- Select one or more Statements/Explanations as to why
the patient is taking the medication or supplement (optional).
- Enter a Start Date, if known.
A Start Date can be a date in the past.
- Review the information entered in the textbook at the end of the
dialog.
- Click the Accept Order
button.
- (Conditional) If the non-VA medication may be contraindicated
because of allergies, drug interactions, or duplicate orders, CPRS will
display the Order Check window. Carefully review all order checks and
either click the Accept Order button or the Cancel Order button.
- When you finish documenting non-VA
medications, click the Quit
button.
Note: Non-VA Meds do not
require an electronic signature. At the
end of the current CPRS session, you will see the Review/Sign Changes window
and will be able to click on the OK
or Cancel button without signing the
order. After you click the OK button, you may see the Order Checks
screen if there is a potential conflict between a non-VA med and an existing
inpatient or outpatient order.
Blood Products
CPRS enables providers to order blood products. The Blood
Components and Diagnostic Test Orders dialog has three tabs: Patient
Information, Orders, and Lab Results. Because this dialog is modal, meaning
that it stays on top of CPRS, these tabs enable the provider to have the
necessary information at the time of ordering.
If the user selects an item under the Order tab’s Write
Orders pane or from an order menu, the Blood Components and Diagnostic Test
Order Form dialog opens to the Patient Information tab. But, if the user
selects a quick order that is not an auto accept quick order or elects to edit
or copy an existing order, the dialog will open to the Blood Bank Orders tab.
The Patient Information Tab
The Patient Information tab displays identifying information
for the selected patient (name, social security number, and blood type), along
with the following information:
● Lab Specimen – The Lab Specimen ID number and the expiration date for
the specimen taken from the patient for diagnostic tests, such as type and
screen. The expiration is 3 days from the time the specimen was accessioned. 3
days is a default that the site can change using a CPRS parameter.
● Antibodies
Identified – Any antibodies identified in
the type and screen are displayed here.
● Transfusion
Requirements – VBECS provides any
necessary instructions or needs for transfusion display here.
● Transfusion
Reactions – Any reactions the patient had
during a transfusion are shown here.
● Available Units
o
Unit ID – The blood
bank number assigned to the unit.
o
Component – This shows
the type of component.
o
Status – There are 4
statuses:
▪ Assigned – A unit identified for a patient but has not been
crossmatched.
▪ Crossmatched – The unit has been designated as typed and
crossed.
▪ Autologous – The unit is the patient’s blood that was
previously donated for the patient’s use.
▪ Directed – This unit was donated with the intention that it
would be given to this patient.
o
Expiration Date – This
date represents when the unit is no longer good.
o
Division – The name of
the division where the blood component is located.
The Blood Bank Orders Tab
On the Blood Bank Orders tab, providers can place orders for
blood components and diagnostic tests that need to be done before the
components can be given to the patient. As with many types of orders, the user
can create personal quick orders for blood components and tests the user
frequently orders.
On this dialog the user specifies:
▪ Blood Components – The list of items comes from CPRS from a parameter and
shows what blood products can be offered. Items might include:
o
Red blood cells
o
Fresh frozen plasma
o
Platelets
o
Cryoprecipitate
o
Whole blood
o
Other
▪ Modifiers – The modifiers are controlled by a parameter that is set
at each site. It might include things such as washed, irradiated, etc.
▪
For All Components--Date/Time Wanted* - The date and time when the blood components should be
ready that enables the user to order the blood for a future date, such as for a
surgery.
▪ Urgency* – This list comes from CPRS and might include items such
as Routine, Pre-op, ASAP, or STAT. The urgency applies to all items listed
under the Selected Components and Tests area.
▪ Surgery
(conditional) – If the user selects Pre-Op
for the urgency, the Surgery field becomes active and the provider can select
the surgery to be performed from the drop-down list or enter it manually. If
the surgery is not listed, the provider may enter a surgery (the field accepts
free-text) because this is not a comprehensive list of surgeries.
▪ Reason for
Request* – The user can choose a reason
from the drop-down list (sites define items in the list using a parameter) or
type a free-text entry. This reason for request applies to the entire
order.
▪ Comment* – If the provider has information that should be passed on
with the order, the comments can be added in this field. The comments apply to
the entire order. (This is a required field if the user selects the Blood
Component “Other.”)
▪ Diagnostic Tests – The items on this list comes from CPRS and enable the
provider to request specific tests associated with blood component ordering.
When the user selects this item, the fields under blood components are then
cleared. The user can see those items again by highlighting the blood component
under Selected Blood Components and Tests.
▪ Collection Type* – The collection type determines how the specimen should
be collected: Lab collect, Ward collect, Send patient to Lab, or Immediate
collect, for example.
▪ Collection
Date/Time* – The date and time enable the
user to specify when the sample should be collected.
Items required to order each blood component or diagnostic
test are marked with an asterisk (*) after the name of the field, such as
Reason for Request*.
How the Blood Orders Tab Works
Ordering blood components and diagnostic tests is different
than ordering other items in CPRS because users can place orders for several
different blood components and tests in one dialog at the same time. For
example, if a user wanted to order platelets, whole blood, and a type and
screen, the user could do all of that in the dialog at the same time. To accommodate ordering of multiple items,
the Blood Bank Orders tab creates a list of items ordered under the Selected
Components and Test area.
When the user selects a blood component from the Blood
Component drop-down list, the item is immediately added to the Selected
Components and Tests area (think of this as a shopping cart like some web sites
use). The user can then detail the necessary information for that component,
such as quantity, modifiers, date and time wanted for all blood components, the
urgency and reason for request, etc.
When the user puts in data for these fields, these values
will stay in when the user switches between components or tests. Because the
values that apply to the entire order continue to display, the user can select
items and enter the other values for each component and diagnostic test.
Alternatively, the user could select all of the components
and tests first, then select each item under the Selected Components and Tests
list and fill in each individually. To edit any item, the user must either fill
in the fields as soon as the item is selected from the drop-down list or
highlight the item in the Selected Components and Tests list and then edit the
fields.
Under the Selected Components and Test area, the user can
also remove a single item by selecting the item and selecting the Remove
button, or if the user wants to remove all the items, the user can select the
Remove All button.
Based on the set up, CPRS may prompt the user that the
selected blood component requires a specific diagnostic test. For example, if
the user selects whole blood and the patient does not have a Type and Screen
within the last 3 days (3 days is a default, clinical coordinators at the sites
can set the number of days based on local policy), the user will see a message
under the diagnostic test drop-down box stating that a Type and Screen is
required.
As the user enters orders, the order text is built in the
field at the bottom of the dialog. Thus, the user should review this area to
ensure that all necessary information is included with each item.
To help the user edit the values that go along with each
component and test, several values that apply to the entire order now remain
visible:
● Date/Time Wanted for ALL components
● diagnostic test Collection Type
● diagnostic test Collection Date/Time
● Comments
● Reason for Request
● Urgency
The Date/Time Wanted for All Component (as the name implies)
applies to all blood components and defaults for the diagnostic tests.
Modifiers apply only to blood components.
Also, when the user moves the focus to either the Blood
Components or the Diagnostic Tests area, values for the last item entered in
that area display so that the user can edit the values. If the user wants to
edit another item, the user must select it from the Selected Components and
Test area first.
Configuring the VBECS Dialog
Each site can configure some areas of the Blood Component
and Diagnostic Test Order Form dialog. A CPRS parameter lets sites decide if
the Blood Component area or the Diagnostic Test area is shown on the left of
the dialog. The other area then displays next to the first area on the right of
the dialog.
Sites can also customize the order of the following lists:
● The Blood Components
● The Diagnostic Tests
● The Reason for Request
The order of items in these lists is controlled by
parameters set by Clinical Application Coordinators (CACs). CACs can therefore
put the most used items earlier in the list.
Ordering Blood Components and Diagnostic Tests
Use the following instructions to order blood components and
associated diagnostic tests. Remember that from this dialog, unlike other CPRS
ordering dialogs, you can order several different items from the same dialog.
As with many CPRS order dialogs, users can create personal
quick orders and then use them to place these orders. A Clinical Application
Coordinator (CAC) at your site can also create quick orders and place them on
an order menu for users.
To order blood
components and diagnostic tests, use these steps:
1.
Go to the Orders tab, by clicking on the tab or
pressing Ctrl + O.
2.
Under Write Orders,
select Blood Bank (or whatever your site names the VBECS item).
3.
Review the Patient
Information tab for pertinent information.
4.
Select the Blood Bank
Orders tab.
The following dialog will appear.
This dialog enables users to
electronically enter orders for blood products and diagnostic tests, view
information about blood products related to this patient, and view lab
information, if available, related to the blood product or test selected. The
location of the Diagnostic Tests and Blood Components areas might be switched
at different sites because this can be configured at each site. Date/Time
Wanted applies to all components.
5.
Select the needed
blood component from the drop-down list. (When the user selects a blood
component or a diagnostic test, the quick order field is no longer
displayed).
Note: For some blood
components, a message may appear under the Diagnostic Test drop-down list
indicating that a diagnostic test, such as a type and screen, is needed.
However, you may want to complete all the fields for the blood component first.
Otherwise, you will have to switch back to fill out the needed fields. Also, if
there are lab results, they will now be on the Lab Results Available tab.
6.
Enter the quantity.
7.
(Optional) Select a
modifier from the list if needed.
8.
Indicate when all
blood product components are needed by accepting the default of Now, typing in
date, or using the calendar control (the button with three dots) to select a
date and time.
9.
Select the urgency
from the drop-down list.
10.
If you select Pre-Op,
you must select a surgery from the drop-down list.
11.
If you select Pre-Op
and choose a surgery, the Reason for Request field is automatically populated
with the surgery. However, you can also type in a reason for request. (It must
be less than 76 characters.)
Note: If you select a
surgery that is listed in the MSBOS as not requiring blood components, CPRS
displays a dialog warning that no blood is required for the surgery. The MSBOS
contains a list of how many units of blood are generally used for the specified
surgery.
12.
Under Comment, type
any needed comments.
13.
If a diagnostic test
is needed, select the appropriate test under Diagnostic tests.
Note: When you choose a
diagnostic test, the fields relating to the blood component are cleared. If you
want to see or edit them again, highlight the blood component under the Blood
Component and Diagnostic Test area.
14.
Select the collection
type from the drop-down list.
Note: Which collection type
the user selects first affects the default start time that displays. If Ward
Collect is selected first, the default is NOW and stays NOW even if Send
Patient is then selected. If Send
Patient is selected first, then the default is TODAY and stays TODAY even if
Ward Collect is then selected. Immediate collect defaults to a time 10 minutes
in the future.
15.
Enter the time and
date for the specimen collection.
16.
To order more blood
components, repeat steps 5-12.
17.
To order additional
diagnostic tests, repeat steps 13-15.
18.
When you have
finished, review the order text at the bottom of the dialog.
19.
When you have the
order defined as wanted, select Accept
Order.
Note: For nursing administration orders, sites will have to create
their own orders.
To create blood
component and diagnostic test personal quick orders, use these steps:
- Follow steps 1-18 above.
- Instead of selecting Accept Order, go to the main CPRS window and
select Options | Save as Quick Order….
- In the Add Quick Order (Blood Bank) dialog, type the name for your
personal quick order.
- If you want to change where the order will appear in the list,
highlight the order and use the arrow buttons on the left of the dialog to
move it up or down in the list.
- Select OK.
After
creating the personal quick order, the next time you open the Blood Components
and Diagnostic Tests Order Form, your personal quick orders will be listed in
the first field.
Note: For nursing
administration orders, sites will have to create their own orders.
To place blood bank
orders using personal quick orders, use these steps:
- Go to the Orders tab, by clicking on the tab or pressing Ctrl + O.
- Under Write Orders, select Blood Bank (or whatever your site names
the VBECS item).
- Select the Blood Bank Orders tab.
- Select the appropriate personal quick order
from the drop-down list.
Note: If you inadvertently
select the wrong quick order, you can choose Remove All or Cancel to exit the
dialog and then reenter the dialog.
- Make any changes or additions as needed. Remember that to change
part of an order you must highlight that item in the list first.
- When finished, select Accept Order.
Note: For nursing
administration orders, sites will have to create their own orders.
The Lab Results Tab
The Lab Results tab enables clinicians to view the lab
results associated with the selected blood component. If there are lab results
in the system when the user selects a blood component, the tab name changes to
Lab Results Available. This tab then shows the results from the lab tests
designated in VBECS by the administrator at each site. So, for example, the
user might see different lab test results based on whether the user selected
whole blood or platelets.
Note: The most recent results are displayed, but
these results may be from tests done some time in the past. Users should use
good judgment as to whether they should order a new test.
Infusion Orders
There are several different kinds of infusion orders,
including intravenous (IV), epidural, IV piggyback, etc.
In the Infusion Order dialog, the order type—Continuous or
Intermittent— affects whether some fields are available or visible. The two
types of IVs are defined as follows:
●
Continuous IV: an IV
that runs at a specified rate (ml/hr, mcg/kg/min, etc.).
●
Intermittent IV: an IV
administered at scheduled intervals (Q4H, QDAY) or
One-Time only, “over a specified period of time” (e.g.,
“Infuse over 30 min.”).
For Intermittent orders, the Infusion Rate field changes to
be Infuse over Time, the
Schedule field becomes available (not greyed out), and
checkboxes display for the PRN and Give Additional Dose Now options. On both
dialogs, required fields are identified by an asterisk following the field
label (such as Route*, for example). Intermittent orders no longer require a
solution to finish the order. Continuous orders still require a solution before
the order can be finished. For CPRS to accept the order, the user must enter
values in the required fields, including the units.
For the Route field, CPRS uses the following rules to define
whether it displays a default route for the selected medication:
● If all of the orderable items on the order have the same
default medication route defined, CPRS designates the default medication route
in the selection list.
● If one or more orderable items on the order have different
default medication routes, no medication route in the selection lest will be
denoted as the default.
Placing Continuous Infusion Orders
Continuous infusion orders run at a specified rate. As the
user selects a solution and/or additive, the items from that list are displayed
to the right under Solution/Additive. For continuous infusion orders the only
optional fields are the Comments and the Duration or Total Volume fields. The
schedule field is not available.
With the CPRS GUI v.28, a new Additive Frequency field was
added to the Infusion Order dialog. Users must select from this field into
which IV bag the additive should be placed:
● 1 Bag/Day: The additive should be put in one bag for 24
hours, normally the first bag.
● All Bags: The additive should be placed in all bags given
to the patient.
● See Comments: The provider wants something other than the
above options and will put appropriate instructions in the Comments box.
Note: If the user selects
“See Comments” for the Additive Frequency but does not enter appropriate
instructions in the Comments box, Pharmacy may interpret that as All Bags.
To order continuous
infusion orders, follow these steps:
- Select the Orders tab.
- Select the active orders view from the View Orders pane -or- select
View | Active Orders (includes pending, recent activity).
- Select Infusion (or your site’s equivalent)
in the Write Orders list box.
Note: The Infusion item may
be labeled differently or may not be available from your Write Orders list box.
The Infusion
Order dialog displays as shown below.
The Infusion Order dialog for
continuous infusion orders does not use a schedule, but it does have an
infusion rate. For continuous infusion orders, the new Additive Frequency field
enables providers to indicate into which IV bag the additive should be placed
Note: If encounter
information has not been entered, the encounter information dialog will appear
before the Infusion Order dialog. You must complete the encounter information
dialog before proceeding.
- Select the needed solutions from the Solutions tab.
- Select an additive from the list (if necessary) and edit the
strength if needed. Repeat for
additional additives if necessary. How users can edit the strength field
will depend on the values for strength defined in the pharmacy files as
follows:
o
If a single strength
is defined, users cannot edit the field.
o
If multiple values for
strength are defined in the pharmacy files, the field will have a drop-down
list from which users can choose a strength.
o
If no values have been
defined, users can type in a strength. If a strength includes a decimal point,
the value must begin with a number: so, .5 is not valid, but 0.5 is.
The solution
and additives you select will appear in the Solution/Additive grid.
Note: To remove an additive
or a solution, select the solution or additive and select Remove.
- Enter a volume and strength in the Solution/Additive
grid (if necessary).
- Select the Additive Frequency from the list:
o
1 Bag/Day: The
additive should be put in one bag for 24 hours, normally the first bag.
o
All Bags: The additive
should be placed in all bags given to the patient.
o
See Comments: The
provider wants something other than the above options. Enter the appropriate
instructions in the Comments box.
- Select a Route (such as intravenous, epidural, IV piggyback, etc.)
If the desired route is not available, select the Other option in the list
of routes to bring the expanded med route form that lists all possible IV
routes.
- In the Type field, select Continuous.
Note: If you change the IV
Type from Continuous to Intermittent, the Schedule field becomes available and
the Infusion Rate field becomes the Infusion over Time field.
Note: For a definition of
Continuous and Intermittent orders, select the IV Type Help link and a message
box will display with a short definition of what the terms mean.
- Enter an infusion rate in ml/hr.
- Select a Priority.
- (Optional) Enter a number for the duration or total volume of
fluids for this order.
- Select the appropriate unit (liters-L,
milliliters-ml, days, or hours).
Note: If you change the
units, the value in the Duration or the Total Volume field will be removed and
you will need to enter it again. This is a safety feature to ensure the patient
does not receive a dangerous amount of fluid.
- Enter an Indication. If they have been entered, you
can use the drop-down list and select the indication or you can type an
indication in the field.
- Enter any comments (if necessary).
- Review the order text at the bottom of the dialog to ensure that it
is correct.
- Select Accept Order.
- Enter another order
-or-
Select Quit.
Note: The order must be signed before it is sent. You can either
sign the order now or wait until later.
Changing or Renewing Continuous
Infusion Orders
Users can change and renew Continuous Infusion orders.
A user will not be able to renew an existing Continuous IV
Order if the additive frequency value is not defined. The user will be forced
into the order dialog when taking another action (Change, Transfer) on an
existing Continuous IV Order that does not have an additive frequency value
defined.
However, if the continuous infusion order with an additive
frequency was placed previously, the order will come back into the dialog with
the additive frequency with which Pharmacy finished the order in the Prev. Add.
Freq. field that is not editable.
This
screen capture shows the Infusion Order dialog when the user tries to change. A
new field displays what the additive frequency was previously. This can help
the user decide what additive frequency to select.
If Pharmacy did not place anything in that field, it was the
same as putting All Bags, but the field will not read All Bags. Additionally,
the pharmacist could have entered a value that is acceptable in Pharmacy, but
not in CPRS, such as “second bag.”
If the value was accepted before, it will come into the
dialog and will display, but it may not be accepted.
The only acceptable values for Additive Frequency in CPRS
are 1 Bag/Day, All Bags, or See Comments. And if the user put See Comments,
there must be something entered in the Comments box.
Placing Intermittent Infusion Orders
Intermittent infusion orders have many of the same required
fields as continuous orders, but there are some important differences.
Intermittent refers to an infusion order administered at scheduled intervals
(Q4H, QDAY) or One-Time only, “over a specified period of time” (e.g., “Infuse
over 30 min.”). For intermittent infusion orders, as the user selects a
solution and/or additive, the items from that list are displayed to the right
under Solution/Additive. For Intermittent infusion orders the only optional
fields are the Comments, Infuse Over, and the Duration or Total Volume
fields.
However, for intermittent orders, the Infusion Rate field
changes to the Infuse Over Time field where the user enters either a number of
minutes or hours. the schedule field is not available.
To order intermittent infusion
orders, follow these steps:
- Select the Orders tab.
- Select the active orders view from the View Orders pane -or- select
View | Active Orders (includes pending, recent activity).
- Select Infusion (or your site’s equivalent)
in the Write Orders list box.
Note: The IV fluids item
may be labeled differently or may not be available from your Write Orders list
box.
The Infusion Order dialog displays
as shown below.
The
Infusion Order dialog for intermittent infusion orders
Note: If encounter
information has not been entered, the encounter information dialog will appear
before the Infusion Order dialog. You must complete the encounter information
dialog before proceeding.
- Select a solution from the Solutions tab.
After you select a solution, CPRS
automatically moves to the Additives tab.
- Select an additive from the list (if
necessary). Repeat for additional
additives if necessary.
The solution and additives you
select will appear in the Solution/Additive grid.
Note: To remove an additive or a solution, select the solution or
additive and click Remove.
- Enter a volume and strength in the Solution/Additive
grid (if necessary).
- Select the Route (for example, intravenous, epidural, IV piggyback,
etc.) from the drop-down list. If the desired route is not available
select the Other option in the list of routes to bring the expanded med
route form that list all possible IV routes.
- In the Type drop-down box, select
Intermittent.
Note: If you change the IV
Type from Intermittent to Continuous, the Schedule field becomes unavailable
(greyed out) and the Infusion over Time field becomes the Infusion Rate
field.
Note: For a definition of
Continuous and Intermittent orders, select the IV Type Help link and a message
box will display with a short definition of what the terms mean.
- Select a schedule from the list or create
one using the Day-of-Week schedule builder.
Note: When a user writes an
intermittent infusion order with a schedule of ONCE, the following will happen
in CPRS:
o
The DURATION field
will be disabled.
o
The Give Additional
Dose Now option will be disabled
o
Expected First Dose
and Administration Times will not be displayed
Note: When a user writes
an intermittent infusion order with a schedule of On Call or a PRN, the
following will happen in CPRS:
o
Expected First Dose
and Administration Times will not be displayed
- If you selected an existing schedule, skip to step 13. If you
selected OTHER, CPRS displays the Order with Schedule ‘OTHER’ dialog. Take
the following steps:
a.)
Select one or more
checkboxes by the appropriate days of the week.
b.)
If the schedule
requires specific administration times skip to steps c and d. To select a
schedule from the list, highlight the schedule and select Add.
Note: Users can assign either a schedule from the list or specific
administration times, but not both.
c.)
To use a specific
administration time, select the hour and minutes (if the user only selects the
hour, the minutes will default to zero) and select Add.
d.)
Repeat step c until
you have entered all required administration times.
Warning: The administration times in
the Schedule field apply to each day of the week that is listed, such as
TU-TH-SA@08002000, for example. To create a schedule such as TU@0800 TH@2000,
users would have to enter two separate orders using the complex medication
order dialog. Also, users may not enter a schedule that only has administration
times and PRN but no days.
e.)
If you make a mistake
while selecting an administration time or schedule, do one of the following to
remove it:
o
For a single
administration time, highlight the hour and minutes in the Set Administration
Time fields and select Remove (so to
remove 08:00, you would have to select that time in the Set Administration Time
fields not in the Schedule text box.)
o To remove the schedule,
highlight the schedule and select Remove.
o
To remove the entire
schedule and begin again with step a, select Reset.
f.)
Review the Schedule field.
g.)
When you have the
correct schedule, select OK.
- If necessary, select the PRN checkbox.
- Enter the number for the duration over which to infuse the
medication.
- Move to the next field and select the unit
of time (the units can be only Minutes or Hours) over which the infusion
should be given.
For example, you might enter 30 for
the number, move to the next field, and then select minutes to define infuse
over 30 minutes.
- Select the Priority.
- Enter a number for the duration or total volume.
- Move to the next field and select the
appropriate unit (liters-L, milliliters, days, hours, or doses).
Note: If you change the
units, the value in the Duration or the Total Volume field will be removed and
you will need to enter it again. This is a safety feature to insure the patient
does not receive a dangerous amount of fluid.
- If necessary, select the Give additional
dose now checkbox.
Note: Make sure that you
are careful about using give-additional-dose now functionality. When you click
the check box, CPRS creates two new orders and sends it to Inpatient
Medications. Make sure the “Give additional dose now” and the regular order
with the original schedule you entered do not overmedicate the patient. “Give
additional dose now” is not available for ONCE, ONE-TIME, or NOW orders. It is
also not available for delayed orders.
- Enter an Indication. If they have been entered, you
can use the drop-down list and select the indication or you can type an
indication in the field.
- Enter any comments (if necessary).
- Review the order text at the bottom of the dialog to ensure that it
is correct.
- If the order text is correct, select Accept Order.
- Enter another order
-or-
Select Quit.
Note: The order must be signed before it is sent. You can either
sign the order now or wait until later.
Entering Simple Supply Orders
Ordering supplies has changed a
little in CPRS. Previously, supplies were included in the Medication Order
dialog. This was not an ideal situation because those who might only be tasked
with ordering supplies might inadvertently select a medication. In addition,
nurses and clerk might also have to have additional permissions to order
supplies that would allow them to order medications as well.
To place simple
supply orders, use the following steps:
- On the Order tab under the Write Orders
pane, select Supplies.
- In the Supplies order dialog, select the
item from the list (you can type part of its name in the text box to move
to that part of the list and then select the item).
- On the Dosage tab, select or type a
dosage.
- If a Route is needed, select or type an
acceptable route.
- Select a schedule.
- Type any comments.
- Type a Days Supply.
- Type a Quantity.
- Enter a number of Refills.
- Under Pick up, select how patient will
receive the supply: Clinic, Mail, or Window.
- Under Priority, use the drop-down box to
select the priority.
- Review the order text at the bottom of the
dialog. If it is correct, select Accept Order. If something is not
correct, correct that portion that is wrong. To cancel the process, select
Quit.
Entering Complex Supply Orders
Ordering supplies has changed a little in CPRS. Previously,
supplies were included in the Medication Order dialog. This was not an ideal
situation because those who might only be tasked with ordering supplies might
inadvertently select a medication. In addition, nurses and clerk might also
have to have additional permissions to order supplies that would allow them to
order medications as well.
To place complex
supply orders, use the following steps:
- On the Order tab under the Write Orders pane, select Supplies.
- In the Supplies order dialog, select the item from the list (you
can type part of its name in the text box to move to that part of the list
and then select the item).
- After selecting the item, select the Complex tab.
- Enter a Dosage by selecting on from the drop-down list or typing an
appropriate dosage into the field.
- Enter a Schedule using the drop-down list or by typing one in the
Schedule field.
- Enter a Duration and the unit of time (such as days, hours, weeks,
etc.).
- Select a conjunction (and or then) unless this is the last line.
- Repeat steps 4-7 until you have the entire complex order entered.
- (Optional) Type a Comment if needed.
- Enter a Days Supply.
- Enter a Quantity.
- Enter the number of Refills, if any.
- Select how the patient will receive the supply items (Clinic, Mail,
or Window).
- Select a Priority from the drop-down list.
- Review the SIG to make sure it is correct.
- Make any corrections as needed.
- When the order is ready, select Accept Order.
- If the Order Check window displays, review all order checks and act
appropriately.
- When finished, you can enter a new supply
order or select Quit to exit the dialog.
Ordering Lab Tests
To place an order for a lab test, follow these steps:
- Select the Orders tab.
- Select the active orders view from the View Orders pane -or- select
View | Active Orders (includes pending, recent activity).
- Select Lab Tests in the Write Orders list.
Note: The lab tests order
may be labeled differently or may not be available from your Write Orders
field.
The Order a Lab Test dialog will
appear.
The Order a Lab Test dialog
Note: If encounter
information has not been entered, the encounter information dialog will appear
before the Order a Lab Test dialog. You must complete the encounter information
dialog before proceeding.
- Select the desired lab test in the Available Lab Tests list box.
- If desired, change the default values for the Collection Sample,
Specimen, and/or Urgency fields. If you cannot change a field, the text
label (to the left of the field) will be dimmed.
- Select the collection type.
- Choose a collection date and time.
- Complete the How Often? and How Long? fields (if necessary).
- Select Accept Order.
Note: If you have selected
an inpatient order with a collection type of “lab collect” or “immediate
collect” and if a continuous schedule was selected (such as QD or QWEEKLY) and
a child order falls on a day when the lab cannot perform the collection (for
example, weekends or holidays), CPRS displays a message telling the user that
the collection type will be changed to “ward collect” or of any such changes to
child orders.
- Enter another lab test
-or-
select Quit.
Note: The Lab Test order
must be signed before it is sent. You can either sign the order now or wait
until later.
Anatomic Pathology Orders
(Overview)
Atomic Pathology (AP)
laboratory service now has a mechanism for clinicians to provide required
patient-specific, procedure-specific, and specimen-specific information to
facilitate specimen processing by pathologists.
A new Anatomic
Pathology Order Dialog is available with the following available order types:
●
Bone Marrow
●
Bronchial Biopsy
●
Bronchial
Cytology
●
Dermatology
●
Fine Needle
Aspirate
●
Gastrointestinal
Endoscopy
●
General Fluid
●
Gynecology (Pap
Smear)
●
Renal Biopsy
●
Tissue Exam
●
Urine
●
Urology,
Bladder/Ureter
●
Urology, Prostate
When
opening the Anatomic Pathology order dialog, you must first select one of the
available order types, such as seen below, for example Bone Marrow, Bronchial
Biopsy, etc.
Because each order type may require different information, different order
dialog fields display when the user selects an order type.
Common Areas of Anatomic Pathology Order Dialogs
- Order-specific fields such as Urgency and Collection Date/Time.
- List of Specimens for this order.
- The Current Specimen being viewed in box 4.
- Specimen-specific fields, such as the Specimen Description/Anatomic
Site and Collection Sample.
- Button to delete the current specimen.
- Several Multiple tabs to enter free text
fields, such as Clinical History.
In box 2 above, the Current Specimen List:
•
Some dialogs have a “+” button at the top of the
list of specimens. Click this button to
add an additional specimen.
Other
dialogs have a dropdown list. When first
selecting these dialog types, the dropdown list will automatically open. Select an entry from the list to create your
first specimen.
● To
add an additional specimen, you must click on the down arrow button to open the
list of types. Select an option from the
dropdown list to add an additional specimen.
•
To navigate between specimens, click the entry
in the list. The current specimen is
shown on the right.
Each dialog has a different set of
specimen-specific fields. Some examples
are:
Selections made in the
specimen-specific fields will be displayed in the Specimen Description/Anatomic
Site field, shown at the top of the above examples. The user can also edit the
Specimen Description/Anatomic Site field directly. This is a required field with a maximum
length of 75 characters. If the maximum character length is exceeded, a warning dialog will be
displayed to the user as shown below.
If this happens you may need to edit the text of the
Specimen Description/Anatomic Site field to ensure it conveys the desired
information.
At the bottom of the Anatomic Pathology order dialog are one
or more text fields. Select the tab
header of each field to edit the text.
Required fields are marked with an asterisk.
Some dialogs have additional Clinical History fields.
Selecting any of these additional fields satisfies a text
entry requirement for Clinical History.
Note that when selecting the Additional Clinical History box to type
text, it will automatically expand the field to the full width of the dialog,
hiding the additional Clinical History fields.
This is temporary, these fields will return when exiting the Additional
Clinical History control (e.g. you can click on the Clinical History tab header
to make the additional fields reappear).
Review the Order before Accepting
Choosing Accept Order displays a preview dialog with all the
order details displayed.
Selecting the Back button will return you to the order
dialog. Or the user can select Accept Order.
Order Details
After the order is accepted, it can be viewed on the Orders
tab. Users must sign the order before it will be available in the Lab package.
The order number and the lab number are both available in
the CPRS Order Details display.
Requisition and Labels
After the order is completed, your local site will need to
follow your procedures for creating a requisition and specimen label. One
possibility is to print the order details and use them in place of the SF 515
as a requisition. While this is one possibility, the site will need to choose
how to handle printing the requisition and labeling the specimen.
Entering a Bone Marrow Lab Test
To place an order for
a Bone Marrow lab test, follow these steps:
- Select the Orders tab.
- Select Anatomic
Pathology from the Write Orders
list.
Note: The orders listed in the Write Orders pane
vary from site to site.
- If the patient is an outpatient, select a Visit Location in the Location for Current Activities
box and choose a visit location.
- Choose the Date/Time of
the visit.
- Select OK.
- Select Bone Marrow in the Available Lab Tests list box. The
Bone Marrow dialog displays as shown below.
Bone Marrow dialog
- Select the Specimen Description on the left
side of the dialog box and choose a specimen. If this is the first
specimen, use the +key located above the Specimen Description field. Use
the drop-down list for subsequent specimens.
Note: At least one
specimen along with a specimen description is required to process an order.
- If desired, change the default values for Urgency and/or Collection
Date/Time fields. These are required fields.
- If desired, enter your name in the Specimen Submitted By field. This is an optional field that is
intended for the name of the person entering the order.
- Select the Surgeon/Physician
field and choose a surgeon/physician.
- If desired, enter a comment in the Order comment field. This is an optional field that allows
letters, numbers, punctuation, and spaces.
- Select the Source. Choose a source for the specimen (Left Anterior Iliac Crest,Left Posterior Iliac Crest,Right
Anterior Iliac Crest,Right Posterior Iliac Crest, or Sternum).
Note: The selection made
in this field will appear in the Specimen Description field above.
●
If desired, select the
X button to delete the entry. Deleting the entry will result in a CPRS
Patient Chart Warning dialog box; select the Yes button to confirm the deletion or select the No button to cancel the deletion.
- Select the Specimen Type. Choose a specimen type (Aspirate or Core Biopsy).
Note: The selection made
in this field will appear in the Specimen Description field above.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
- If desired, enter a description for the
specimen in the Specimen
Description field. This is a required field with a maximum character
length of 75 which includes letters, numbers, punctuation, and
spaces.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
Note: If you delete a
specimen and there are multiple specimens, the specimen numbers will be
reordered in the Specimen Description list.
- Select the Clinical History
tab. Enter the patient’s history in the Clinical History field. This is a required field that allows
letters, numbers, punctuation, and spaces.
- Select the Pre-Operative
Diagnosis tab. Enter the patient’s pre-operative diagnosis in the Pre-Operative Diagnosis field.
This is a required field that allows letters, numbers, punctuation, and
spaces.
- Select Accept Order.
- Preview the order.
- If desired, modify the order by selecting the Back button, or select the Accept Order button to accept the order.
- If desired, enter another lab test.
-or-Select Accept Order.
-or-Select Quit.
Note: The Lab Test order must be signed before it is sent to
VistA to be accessioned and processed. You can either sign the order now or
wait until later.
Entering a Bronchial Biopsy Lab Test
To place an order for
a Bronchial Biopsy lab test, follow these steps:
- Select the Orders tab.
- Select Anatomic Pathology
from the Write Orders list.
- If the patient is an outpatient, select a Visit Location in the Location
for Current Activities box and choose a visit location.
- Choose the Date/Time of
the visit.
- Select OK.
- Select Bronchial Biopsy
in the Available Lab Tests list
box. The Bronchial Biopsy dialog displays.
- Select the Specimen Description on the left side of the dialog box.
Choose a specimen description. If
this is the first specimen, use the +key located above the Specimen
Description field. Use the
drop-down list for subsequent specimens.
Note: At least one
specimen along with a specimen description is required to process an order.
- If desired, change the default values for Urgency and/or Collection
Date/Time fields. (These are required fields).
- If desired, enter your name in the Specimen Submitted By field.
This is an optional field that is intended for the name of the
person performing the procedure.
- Select the Surgeon/Physician
field. Choose a surgeon/physician.
- If desired, enter a comment in the Order comment field. This is an optional field that allows
letters, numbers, punctuation, and spaces.
- Select the Source. Choose a source for the specimen (Bronchial, Left Lower Lobe (LLL) Bronchial, Left Upper Lobe (LUL)
Bronchial, Lingula, Main Stem Bronchus, Right Lower Lobe (RLL) Bronchial,
Right Middle Lobe (RML) Bronchial, or Right Upper Lobe (RUL) Bronchial).
Note: The selection made
in this field will appear in the Specimen Description field above.
● If desired, select the X
button to delete the entry. Deleting the entry will result in a CPRS Patient
Chart Warning dialog box; select the Yes
button to confirm the deletion or select the No button to cancel the deletion.
- Select the Specimen Type. Choose a specimen type (EBUS-TBNA, Endobronchial Biopsy, or Transbronchial Biopsy).
Note: The selection made
in this field will appear in the Specimen Description field above.
● If desired, select the X
button to delete the entry. Deleting the entry will result in a CPRS Patient
Chart Warning dialog box; select the Yes
button to confirm the deletion or select the No button to cancel the deletion.
- Select the Station. Choose a station(Station
10, Station 2, Station 4, or
Station 7).
●
If desired, select the
X button to delete the entry.
Deleting the entry will result in a CPRS Patient Chart Warning dialog box;
select the Yes button to confirm the
deletion or select the No button to
cancel the deletion.
- Select the Submission Type. Choose a submission type (Fresh, Fixed, or Intra-Op Consult).
Note: The selection made
in this field will appear in the Specimen Description field above.
Note: If Fresh or Intra-Op Consult is selected, the Urgency field will change to STAT;
you will receive a Warning dialog regarding the change.
Note: If you change the Submission Type to Fixed on all of the specimens (whether only one specimen on
the order or multiple specimens on the order), you will need to manually change
the Urgency to Routine if that is desired.
● If desired, select the X
button to delete the entry. Deleting the entry will result in a CPRS Patient
Chart Warning dialog box; select the Yes
button to confirm the deletion or select the No button to cancel the deletion.
- If desired, enter a description for the
specimen in the Specimen
Description field. This is a required field with a maximum character
length of 75 which includes letters, numbers, punctuation, and
spaces.
● If desired, select the X
button to delete the entry. Deleting the entry will result in a CPRS Patient
Chart Warning dialog box; select the Yes
button to confirm the deletion or select the No button to cancel the deletion.
Note: If you delete a
specimen and there are multiple specimens, the specimen numbers will be
reordered in the Specimen Description list.
- Select the Clinical History
tab. Enter the patient’s history in the Clinical History field. This is a required field that allows
letters, numbers, punctuation, and spaces.
- Select the Pre-Operative
Diagnosis tab. Enter the patient’s pre-operative diagnosis in the Pre-Operative Diagnosis field.
This is a required field that allows letters, numbers, punctuation, and
spaces.
- If desired, select the Operative
Findings tab. Enter the patient’s operative findings in the Operative Findings field. This is
an optional field that allows letters, numbers, punctuation, and spaces.
- If desired, select the Post-Operative
Findings tab. Enter the patient’s Post-Operative
Findings. This is an optional field that allows letters, numbers,
punctuation, and spaces.
- Select Accept Order.
- Preview the order.
- If desired, modify the order by selecting
the Back button, or select the Accept Order button to accept the
order.
- If desired, enter
another lab test.
-or-Select
Accept Order.
-or-Select
Quit.
Note: The Lab Test order must be signed before it
is sent to VistA to be accessioned and processed. You can either sign the order
now or wait until later.
Entering a Bronchial Cytology Lab Test
To place an order for
a Bronchial Cytology lab test, follow these steps:
- Select the Orders tab.
- Select Anatomic Pathology
from the Write Orders list.
- If the patient is an outpatient, select a Visit Location in the Location
for Current Activities box and choose a visit location.
- Choose the Date/Time of
the visit.
- Select OK.
- Select Bronchial Cytology
in the Available Lab Tests list
box. The Bronchial Cytology dialog displays.
- Select the Specimen Description on the left side of the dialog box.
Choose a specimen description. If
this is the first specimen, use the +key located above the Specimen
Description field. Use the
drop-down list for subsequent specimens.
Note: At least one
specimen along with a specimen description is required to process an order.
- If desired, change the default values for Urgency and/or Collection
Date/Time fields. (These are required fields).
- If desired, enter your name in the Specimen Submitted By field.
This is an optional field that is intended for the name of the
person performing the procedure.
- Select the Surgeon/Physician
field. Choose a surgeon/physician.
- If desired, enter a comment in the Order comment field. This is an optional field that allows
letters, numbers, punctuation, and spaces.
- Select the Source. Choose a source for the
specimen (Bronchial, Left Lower
Lobe (LLL) Bronchial, Left Middle Lobe (LML) Bronchial, Left Upper Lobe
(LUL) Bronchial, Lingula, Main Stem, Right Lower Lobe (RLL) Bronchial,
Right Middle Lobe (RML) Bronchial, or Right Upper Lobe (RUL) Bronchial).
Note: The selection made
in this field will appear in the Specimen Description field above.
● If desired, select the X
button to delete the entry. Deleting the entry will result in a CPRS Patient
Chart Warning dialog box; select the Yes
button to confirm the deletion or select the No button to cancel the deletion.
- Select the Specimen Type. Choose a specimen type (Bronchial-Alveolar Lavage (BAL), Brushing, Sputum, Wang Needle, or Washing).
Note: The selection made
in this field will appear in the Specimen Description field above.
●
If desired, select the
X button to delete the entry.
Deleting the entry will result in a CPRS Patient Chart Warning dialog box;
select the Yes button to confirm the
deletion or select the No button to
cancel the deletion.
- If desired, enter a description for the
specimen in the Specimen
Description field. This is a required field with a maximum character
length of 75 which includes letters, numbers, punctuation, and
spaces.
● If desired, select the X
button to delete the entry. Deleting the entry will result in a CPRS Patient
Chart Warning dialog box; select the Yes
button to confirm the deletion or select the No button to cancel the deletion.
Note: If you delete a
specimen and there are multiple specimens, the specimen numbers will be
reordered in the Specimen Description list.
- Select the Clinical History
tab. Enter the patient’s history in the Clinical History field. This is a required field that allows
letters, numbers, punctuation, and spaces.
- Select the Pre-Operative
Diagnosis tab. Enter the patient’s pre-operative diagnosis in the Pre-Operative Diagnosis field.
This is a required field that allows letters, numbers, punctuation, and
spaces.
- Select Accept Order.
- Preview the order.
- If desired, modify the order by selecting the Back button, or select the Accept Order button to accept the order.
- If desired, enter another lab test.
-or-Select Accept Order.
-or-Select Quit.
Note: The Lab Test order
must be signed before it is sent to VistA to be accessioned and processed. You
can either sign the order now or wait until later.
Entering a Dermatology Lab Test
To place an order for
a Dermatology lab test, follow these steps:
- Select the Orders tab.
- Select Anatomic Pathology
from the Write Orders list.
- If the patient is an outpatient, select a Visit Location in the Location
for Current Activities box and choose a visit location.
- Choose the Date/Time of
the visit.
- Select OK.
- Select Dermatology in
the Available Lab Tests list
box. The Dermatology dialog displays.
- Select the Specimen Description on the left side of the dialog box.
Choose a specimen description. If
this is the first specimen, use the +key located above the Specimen
Description field. Use the
drop-down list for subsequent specimens.
Note: At least one
specimen along with a specimen description is required to process an order.
- If desired, change the default values for Urgency and/or Collection Date/Time fields. These
are required fields.
- If desired, enter your name in the Specimen Submitted By field.
This is an optional field that is intended for the name of the
person performing the procedure.
- Select the Surgeon/Physician
field. Choose a surgeon/physician.
- If desired, enter a comment in the Order comment field. This is an optional field that allows
letters, numbers, punctuation, and spaces.
- Select the Submission Type. Choose
a submission type (Fresh, Fixed, or Intra-Op Consult).
Note: The selection made
in this field will appear in the Specimen Description field above.
Note: If Fresh or Intra-Op Consult is selected, the Urgency field will change to STAT;
you will receive a Warning dialog regarding the change.
Note: If you change the Submission Type to Fixed on all of the specimens (whether only one specimen on the
order or multiple specimens on the order), you will need to manually change the
Urgency to Routine if that is desired.
● If desired, select the X
button to delete the entry. Deleting the entry will result in a CPRS Patient
Chart Warning dialog box; select the Yes
button to confirm the deletion or select the No button to cancel the deletion.
- Select the Specimen Type. Choose a specimen type (Biopsy, Excision, MOHS, Punch Biopsy 2 mm, Punch Biopsy 3 mm,
Punch Biopsy 4 mm, Punch Biopsy 5 mm, Punch Biopsy 6 mm, Punch Biopsy 7
mm, or Punch Biopsy 8 mm, Shave
Biopsy, or Shave ED&C).
Note: The selection made
in this field will appear in the Specimen Description field above.
Note: If a particular
Punch Biopsy size is not available, you may enter it in the Specimen
Description field. If information is
already in the Specimen Description field, enter the Punch Biopsy size at the
very end of the field and use a comma after the last character in the field
before entering the information.
● If desired, select the X
button to delete the entry. Deleting the entry will result in a CPRS Patient
Chart Warning dialog box; select the Yes
button to confirm the deletion or select the No button to cancel the deletion.
- Select the Laterality.
Choose the laterality (Left,
Midline, or Right).
- If desired, enter a description for the
specimen in the Specimen
Description field. This is a required field with a maximum character
length of 75 which includes letters, numbers, punctuation, and
spaces.
● If desired, select the X
button to delete the entry. Deleting the entry will result in a CPRS Patient
Chart Warning dialog box; select the Yes
button to confirm the deletion or select the No button to cancel the deletion.
Note: If you delete a
specimen and there are multiple specimens, the specimen numbers will be
reordered in the Specimen Description list.
- Select the Clinical
History tab. Enter the patient’s history in the Clinical History field. This is a required field that allows
letters, numbers, punctuation, and spaces.
- Select the Pre-Operative
Diagnosis tab. Enter the patient’s pre-operative diagnosis in the Pre-Operative Diagnosis field.
This is a required field that allows letters, numbers, punctuation, and
spaces.
- If desired, select the Operative
Findings tab. Enter the patient’s operative findings in the Operative Findings field. This is
an optional field that allows letters, numbers, punctuation, and spaces.
- If desired, select the Post-Operative
Findings tab. Enter the patient’s Post-Operative
Findings. This is an optional field that allows letters, numbers,
punctuation, and spaces.
- Select Accept Order.
- Preview the order.
- If desired, modify the order by selecting the Back button, or select the Accept Order button to accept the order.
- If desired, enter another lab test.
-or-Select Accept Order.
-or-Select Quit.
Note: The Lab Test order
must be signed before it is sent to VistA to be accessioned and processed. You
can either sign the order now or wait until later.
Entering
a Fine Needle Aspirate Lab Test
To place an order for a
Fine Needle Aspirate lab test, follow these steps:
- Select the Orders
tab.
- Select Anatomic
Pathology from the Write Orders
list.
Note: The orders listed
in the Write Orders pane vary from site to site.
- If the patient is an outpatient, select a Visit Location in the Location
for Current Activities box and choose a visit location.
- Choose the Date/Time of
the visit.
- Select OK.
- Select Fine Needle Aspirate
in the Available Lab Tests list box.
The Fine Needle Aspirate dialog displays.
- Select the Specimen Description on the left side of the dialog box. Choose a specimen description. If this is the first specimen, use the + key located above the Specimen
Description field. Use the
drop-down list for subsequent specimens.
Note: At least one
specimen along with a specimen description is required to process an
order.
- If desired, change the default values for Urgency and/or Collection
Date/Time fields. These are required fields.
- If desired, enter your name in the Specimen Submitted By field.
This is an optional field that is intended for the name of the
person entering the order.
- Select the Surgeon/Physician. Choose a surgeon/physician.
- If desired, enter a comment in the Order comment field.
This is an optional field that allows letters, numbers,
punctuation, and spaces.
- If desired, enter a
description for the specimen in the Specimen
Description field. This is a required field with a maximum character
length of 75 which includes letters, numbers, punctuation, and
spaces.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
Note: If you delete a
specimen and there are multiple specimens, the specimen numbers will be
reordered in the Specimen Description list.
- Select the Specimen Type. Choose a specimen type (Needle Core
Biopsy, Needle Washing, or Slide).
Note: The selection made
in this field will appear in the Specimen Description field above.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
- Select the Laterality. Choose the laterality (Left, Midline, or Right).
- Select the Clinical History tab.
Enter the patient’s history in the Clinical History field. This is
a required field.
a.
Select a Collection Technique. Choose
the collection technique (CT, Fluoroscopy, or Ultrasound).
b.
If desired, select Additional Clinical History. Enter information for additional clinical
history. This field allows letters,
numbers, punctuation, and spaces.
- Select the Pre-Operative
Diagnosis tab. Enter the
patient’s pre-operative diagnosis in the Pre-Operative Diagnosis field.
This is a required field that allows letters, numbers, punctuation, and
spaces.
- Select Accept Order.
- Preview the order.
- If desired, modify the order by selecting the Back button, or select the Accept Order button to accept the order.
- If desired, enter another lab test.
-or- Select Accept
Order.
-or- Select Quit.
Note: The Lab Test order
must be signed before it is sent to VistA to be accessioned and processed. You
can either sign the order now or wait until later.
Entering a Gastrointestinal Endoscopy Lab Test
To place an order for a
Gastrointestinal Endoscopy lab test, follow these steps:
- Select the Orders
tab.
- Select Anatomic
Pathology from the Write Orders
list.
Note: The orders listed
in the Write Orders pane vary from site to site.
- If the patient is an outpatient, select a Visit Location in the Location
for Current Activities box and choose a visit location.
- Choose the Date/Time of
the visit.
- Select OK.
- Select Gastrointestinal
Endoscopy in the Available Lab Tests list box. The Gastrointestinal Endoscopy dialog
displays.
- Select the Specimen Description on the left side of the dialog box. Choose a specimen description. If this is the first specimen, use the + key located above the Specimen
Description field. Use the
drop-down list for subsequent specimens.
Note: At least one
specimen along with a specimen description is required to process an
order.
- If desired, change the default values for Urgency and/or Collection
Date/Time fields. These are required fields.
- If desired, enter your name in the Specimen Submitted By field.
This is an optional field that is intended for the name of the
person entering the order.
- Select the Surgeon/Physician. Choose a surgeon/physician.
- If desired, enter a comment in the Order comment field. This is an optional field that allows
letters, numbers, punctuation, and spaces.
- Select the Technique. Choose the
technique (Biopsy, Brushing, EMR, FNA, Hot Biopsy, or Hot Snare).
Note: The selection made
in this field will appear in the Specimen Description field above.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
- Select the Specimen Type. Choose a
specimen type (Erosion, Lesion, Mass, Polyp, Random, or Ulcer).
Note: The selection made
in this field will appear in the Specimen Description field above.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
- If desired, enter a description for the
specimen in the Specimen
Description field. This is a required field with a maximum character
length of 75 which includes letters, numbers, punctuation, and
spaces.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
Note: If
you delete a specimen and there are multiple specimens, the specimen numbers
will be reordered in the Specimen Description list.
- Select the Clinical History tab. Enter the patient’s history in the
Clinical History field. This is a required field.
a.
Select an Indication. Choose all of the indications that apply (Barrett’s Esophagus, Candida, Colitis, H.
Pylori, Malignancy, Microscopic Colitis, and/or Sprue).
b.
If desired, select Additional Clinical History. Enter information for additional clinical
history. This field allows letters,
numbers, punctuation, and spaces.
- Select the Operative
Findings tab. Enter the
patient’s operative findings in the Operative Findings field. This is a
required field that allows letters, numbers, punctuation, and spaces.
- Select Accept Order.
- Preview the order.
- If desired, modify the order by selecting the Back button, or select the Accept Order button to accept the order.
- If desired, enter another lab test.
-or- Select Accept
Order.
-or- Select Quit.
Note: The Lab Test order
must be signed before it is sent to VistA to be accessioned and processed. You
can either sign the order now or wait until later.
Entering
a General Fluid Lab Test
To place an order for a
General Fluid lab test, follow these steps:
- Select the Orders
tab.
- Select Anatomic Pathology
from the Write Orders list.
- If the patient is an outpatient, select a Visit Location in the Location
for Current Activities box and choose a visit location.
- Choose the Date/Time of
the visit.
- Select OK.
- Select General Fluid in
the Available Lab Tests list box.
The General Fluid dialog displays.
- Select the Specimen Description on the left side of the dialog box. Choose a specimen description. If this is the first specimen, use the + key located above the Specimen
Description field. Use the
drop-down list for subsequent specimens.
Note: At least one
specimen along with a specimen description is required to process an
order.
- If desired, change the default values for Urgency and/or Collection
Date/Time fields. (These are required fields).
- If desired, enter your name in the Specimen Submitted By field.
This is an optional field that is intended for the name of the
person performing the procedure.
- Select the Surgeon/Physician. Choose a surgeon/physician.
- If desired, enter a comment in the Order comment field. This is an optional field that allows
letters, numbers, punctuation, and spaces.
- When Synovial Cytologic Material is
selected as a specimen, choose the Source
for the specimen (Elbow, Knee, or Toe). The General
Fluid dialog when Synovial Cytologic Material is selected as a specimen
will display as shown below.
Note: The selection made in this field will
appear in the Specimen Description field above.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
- When Pleural
Cytologic Material is selected as the specimen, choose the Laterality for the specimen of
either Left or Right. The General Fluid dialog when Pleural
Cytologic Material is selected as a specimen will display as shown below.
Note: The selection made
in this field will appear in the Specimen Description field above.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
- If desired, enter a description for the
specimen in the Specimen
Description field. This is a required field with a maximum character
length of 75 which includes letters, numbers, punctuation, and
spaces.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
Note: If you
delete a specimen and there are multiple specimens, the specimen numbers will
be reordered in the Specimen Description list.
- Select the Clinical History tab. Enter the patient’s history in the
Clinical History field. This is a required field that allows letters,
numbers, punctuation, and spaces.
- Select the Pre-Operative
Diagnosis tab. Enter the
patient’s pre-operative diagnosis in the Pre-Operative Diagnosis field.
This is a required field that allows letters, numbers, punctuation, and
spaces.
- Select Accept Order.
- Preview the order.
- If desired, modify the order by selecting the Back button, or select the Accept Order button to accept the order.
- If desired, enter another lab test. -or-
Select Accept Order.
-or-
Select Quit.
Note:
The Lab Test order must be signed before it is sent to VistA to be accessioned
and processed. You can either sign the order now or wait until later.
Entering a Gynecology (PAP Smear) Lab Test
To place an order for a
Gynecology (PAP Smear) lab test, follow these steps:
- Select the Orders
tab.
- Select Anatomic Pathology
from the Write Orders list.
- If the patient is an outpatient, select a Visit Location in the Location
for Current Activities box and choose a visit location.
- Choose the Date/Time of
the visit.
- Select OK.
- Select Gynecology
(PAP Smear) in the Available Lab Tests list box. The Gynecology (PAP Smear) dialog
displays.
Gynecology (PAP Smear) dialog
- Select the Specimen Description on the left side of the dialog box. Choose a specimen description. If this is the first specimen, use the + key located above the Specimen
Description field. Use the
drop-down list for subsequent specimens.
Note: At least one
specimen along with a specimen description is required to process an
order.
- If desired, change the default values for Urgency and/or Collection
Date/Time fields. (These are required fields).
- If desired, enter your name in the Specimen Submitted By field.
This is an optional field that is intended for the name of the
person performing the procedure.
- Select the Surgeon/Physician. Choose a surgeon/physician.
- If desired, enter a comment in the Order comment field. This is an optional field that allows
letters, numbers, punctuation, and spaces.
- Select the Specimen
Type. Choose a specimen type of
either Slide or Thin Prep/Liquid Based.
- If desired, enter a description for the
specimen in the Specimen
Description field. This is a required field with a maximum character
length of 75 which includes letters, numbers, punctuation, and
spaces.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
Note: If you delete a
specimen and there are multiple specimens, the specimen numbers will be
reordered in the Specimen Description list.
- Select the Clinical History tab.
Enter the patient’s history in the Clinical History field. This is a required field.
a. If
desired, select Visit Type. Enter a visit type of Screening or Medically
Indicated/Diagnostic.
b. Select
Menstrual Status. Choose the menstrual status (date of Last Menstrual Period, Postmenopausal, or Unknown). This is a
required field.
Note:
If Postmenopausal is selected, you must select a Hormone Therapy as it will be
required.
c. If
desired, select Hormone Therapy. Enter a hormone therapy (Hormone
Replacement Therapy,
No Hormone Therapy, or Vaginal Cream (Hormonal)).
● If desired, select the X
button to delete any entry. Deleting an
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
d. If
desired, select Applicable History. Enter the patient’s applicable history
(Abnormal Bleeding,
Hormones/Birth Control, Hysterectomy, IUD, Not Menstruating, Post Partum, Pregnant, Prior Abnormal PAP
Smear, or Radiation/Chemotherapy).
e. If
desired, select Additional Clinical History. Enter information for additional clinical
history. This field allows letters,
numbers, punctuation, and spaces.
- Select Accept Order.
- Preview the order.
- If desired, modify the order by selecting
the Back button, or select the Accept Order button to accept the
order.
- If desired, enter
another lab test. -or-
Select Accept Order.
-or-
Select Quit.
Note: The Lab
Test order must be signed before it is sent to VistA to be accessioned and
processed. You can either sign the order now or wait until later.
Entering a Renal Biopsy Lab Test
To place an order for a
Renal Biopsy lab test, follow these steps:
- Select the Orders
tab.
- Select Anatomic Pathology
from the Write Orders list.
- If the patient is an outpatient, select a Visit Location in the Location
for Current Activities box and choose a visit location.
- Choose the Date/Time of
the visit.
- Select OK.
- Select Renal
Biopsy in the Available Lab Tests list box. The Renal Biopsy dialog displays as
shown below.
Renal Biopsy dialog
- Select the Specimen Description on the left side of the dialog box. Choose a specimen description. If this is the first specimen, use the + key located above the Specimen
Description field. Use the
drop-down list for subsequent specimens.
Note: At
least one specimen along with a specimen description is required to process an
order.
- If desired, change the default values for Urgency and/or Collection
Date/Time fields. (These are required fields).
- If desired, enter your name in the Specimen Submitted By field.
This is an optional field that is intended for the name of the
person performing the procedure.
- Select the Surgeon/Physician. Choose a surgeon/physician.
- If desired, enter a comment in the Order comment field. This is an optional field that allows
letters, numbers, punctuation, and spaces.
- Select the Specimen Type. Choose a
specimen type (IR Core Biopsy, Open Wedge Biopsy, or Percutaneous Core Biopsy).
Note: The selection made
in this field will appear in the Specimen Description field above.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
- Select the Laterality. Choose a
laterality of either Left or Right.
Note: The selection made
in this field will appear in the Specimen Description field above.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
- Select the Submission Type. Choose
a submission type (Fresh, Fixed, or Intra-Op Consult).
Note: The selection made
in this field will appear in the Specimen Description field above.
Note: If Fresh or Intra-Op Consult is selected, the Urgency field will change to STAT;
you will receive a Warning dialog regarding the change.
Note: If you change the Submission Type to Fixed on all of the specimens (whether only one specimen on
the order or multiple specimens on the order), you will need to manually change
the Urgency to Routine if that is desired.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
- If desired, enter a description for the
specimen in the Specimen
Description field. This is a required field with a maximum character
length of 75 which includes letters, numbers, punctuation, and
spaces.
●
If desired, select the
X button to delete the entry. Deleting the entry will result in a CPRS
Patient Chart Warning dialog box; select the Yes button to confirm the deletion or select the No button to cancel the deletion.
Note: If you delete a
specimen and there are multiple specimens, the specimen numbers will be
reordered in the Specimen Description list.
- Select the Clinical History tab.
Enter the patient’s history in the Clinical History field. This is a required field.
a.
Select Indication for
Biopsy. Choose the indication for biopsy
(Acute kidney injury, Chronic kidney disease, Hematuria, or Proteinuria).
b.
Select Imaging
Technique. Choose the imaging technique
of either CT Scan or Ultrasound.
c.
Select Special Requests. Choose all of the special requests that apply
(Alpha and lambda light chains, BK, Congo red, Electron microscopy (EM), IgG
subtype, Immunofluorescence (IF), Light microscopy (LM)).
d.
If desired, choose Additional
Clinical History. Enter information for
additional clinical history. This field
allows letters, numbers, punctuation, and spaces.
- Select the Pre-Operative
Diagnosis tab. Enter the
patient’s pre-operative diagnosis in the Pre-Operative Diagnosis field.
This is a required field that allows letters, numbers, punctuation, and
spaces.
- If desired, select the Operative
Findings tab. Enter the
patient’s operative findings in the Operative Findings field. This is an
optional field that allows letters, numbers, punctuation, and spaces.
- If desired, select the Post-Operative
Findings tab. Enter the
patient’s Post-Operative Findings. This is an optional field that allows
letters, numbers, punctuation, and spaces.
- Select Accept Order.
- Preview the order.
- If desired, modify the order by selecting the Back button, or select the Accept Order button to accept the order.
- If desired, enter another lab test. -or-
Select Accept Order.
-or-
Select Quit.
Note: The Lab Test order
must be signed before it is sent to VistA to be accessioned and processed. You
can either sign the order now or wait until later.
Entering a Tissue Exam Lab Test
To place an order for a
Tissue Exam lab test, follow these steps:
- Select the Orders
tab.
- Select Anatomic Pathology
from the Write Orders list.
- If the patient is an outpatient, select a Visit Location in the Location for Current Activities box
and choose a visit location.
- Choose the Date/Time of
the visit.
- Select OK.
- Select Tissue Exam in
the Available Lab Tests list box.
The Tissue Exam dialog displays as shown below.
- Select the Specimen Description on the left side of the dialog box. Choose a specimen description. If this is the first specimen, use the + key located above the Specimen
Description field. Use the
drop-down list for subsequent specimens.
Note: At least one
specimen along with a specimen description is required to process an
order.
- If desired, change the default values for Urgency and/or Collection
Date/Time fields. (These are required fields).
- If desired, enter your name in the Specimen Submitted By field.
This is an optional field that is intended for the name of the
person performing the procedure.
- Select the Surgeon/Physician. Choose a surgeon/physician.
- If desired, enter a comment in the Order comment field. This is an optional field that allows
letters, numbers, punctuation, and spaces.
- Select the Procedure. Choose a
procedure for the specimen (Biopsy,
Cervical Biopsy, Cervix Resection, Cone Biopsy, Endocervical Curettage
(ECC), Endometrial w/Pipelle Curettage, Excision, Fallopian Tube(s)
Resection, LEEP, Myomas Resection, Nephrectomy, Ovary(s) Resection,
Prostectomy, Resection, Uterus Resection, Vaginal Biopsy, or Vulvar Biopsy).
Note: The selection made
in this field will appear in the Specimen Description field above.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
- Select the Submission Type. Choose
a submission type (Fresh, Fixed, or Intra-Op Consult).
Note: The selection made
in this field will appear in the Specimen Description field above.
Note: If Fresh or Intra-Op Consult is selected, the Urgency field will change to STAT;
you will receive a Warning dialog regarding the change.
Note: If you change the Submission Type to Fixed on all of the specimens (whether only one specimen on
the order or multiple specimens on the order), you will need to manually change
the Urgency to Routine if that is desired.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
- If desired, enter a description for the specimen in the Specimen Description field. This
is a required field with a maximum character length of 75 which includes
letters, numbers, punctuation, and spaces.
- If desired, select
the X button to delete the
entry. Deleting the entry will
result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion
or select the No button to
cancel the deletion.
Note: If you delete a
specimen and there are multiple specimens, the specimen numbers will be
reordered in the Specimen Description list.
- Select the Clinical History tab. Enter the patient’s history in the
Clinical History field. This is a required field that allows letters,
numbers, punctuation, and spaces.
- Select the Pre-Operative
Diagnosis tab. Enter the
patient’s pre-operative diagnosis in the Pre-Operative Diagnosis field.
This is a required field that allows letters, numbers, punctuation, and
spaces.
- If desired, select the Operative
Findings tab. Enter the
patient’s operative findings in the Operative Findings field. This is an
optional field that allows letters, numbers, punctuation, and spaces.
- If desired, select the Post-Operative
Findings tab. Enter the
patient’s Post-Operative Findings. This is an optional field that allows
letters, numbers, punctuation, and spaces.
- Select Accept Order.
- Preview the order.
- If desired, modify the order by selecting the Back button, or select the Accept Order button to accept the order.
- If desired, enter another lab test. -or-
Select Accept Order.
-or-
Select Quit.
Note: The Lab Test order
must be signed before it is sent to VistA to be accessioned and processed. You
can either sign the order now or wait until later.
Entering a Urine Lab Test
To place an order for a
Urine lab test, follow these steps:
- Select the Orders
tab.
- Select Anatomic Pathology
from the Write Orders list.
- If the patient is an outpatient, select a Visit Location in the Location
for Current Activities box and choose a visit location.
- Choose the Date/Time of
the visit.
- Select OK.
- Select Urine in the Available Lab Tests list box. The Urine dialog displays.
- Select the Specimen Description on the left side of the dialog box. Choose a specimen description. If this is the first specimen, use the + key located above the Specimen
Description field. Use the
drop-down list for subsequent specimens.
Note: At least one
specimen along with a specimen description is required to process an
order.
- If desired, change the default values for Urgency and/or Collection
Date/Time fields. (These are required fields).
- If desired, enter your name in the Specimen Submitted By field. This is an optional field that is
intended for the name of the person performing the procedure.
- Select the Surgeon/Physician. Choose a surgeon/physician.
- If desired, enter a comment in the Order comment field. This is an optional field that allows
letters, numbers, punctuation, and spaces.
- Select the Specimen Type. Choose a specimen type (Bladder Wash, Catheterized Urine, Ileal
Conduit, Left Ureter Wash, Right Ureter Wash, or Voided).
- If desired, enter a description for the
specimen in the Specimen
Description field. This is a required field with a maximum character
length of 75 which includes letters, numbers, punctuation, and
spaces.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
Note: If you delete a
specimen and there are multiple specimens, the specimen numbers will be
reordered in the Specimen Description list.
- Select the Clinical History tab.
Enter the patient’s history in the Clinical History field. This is a required field.
a.
Select Instrumentation 72 hours prior to collection and choose either No or Yes.
b.
Select Cystoscopy and choose either No
or Yes.
c.
If desired, select Additional Clinical History. Enter information for additional clinical
history. This field allows letters,
numbers, punctuation, and spaces.
- Select the Pre-Operative
Diagnosis tab. Enter the
patient’s pre-operative diagnosis in the Pre-Operative Diagnosis field.
This is a required field that allows letters, numbers, punctuation, and
spaces.
- Select Accept Order.
- Preview the order.
- If desired, modify the order by selecting the Back button, or select the Accept Order button to accept the order.
- If desired, enter another lab test. -or-
Select Accept Order.
-or-
Select Quit.
Note: The Lab Test order
must be signed before it is sent to VistA to be accessioned and processed. You
can either sign the order now or wait until later.
Entering a Urology, Bladder/Ureter Lab Test
To place an order for a
Urology, Bladder/Ureter lab test, follow these steps:
- Select the Orders
tab.
- Select Anatomic
Pathology from the Write Orders
list.
Note: The
orders listed in the Write Orders pane vary from site to site.
- If the patient is an outpatient, select a Visit Location in the Location
for Current Activities box and choose a visit location.
- Choose the Date/Time of
the visit.
- Select OK.
- Select Urology,
Bladder/Ureter in the Available Lab Tests list box. The Urology, Bladder/Ureter dialog
displays.
- Select the Specimen Description on the left side of the dialog box. Choose a specimen description. If this is the first specimen, use the + key located above the Specimen
Description field. Use the
drop-down list for subsequent specimens.
Note: At least one
specimen along with a specimen description is required to process an
order.
- If desired, change the default values for Urgency and/or Collection
Date/Time fields. These are required fields.
- If desired, enter your name in the Specimen Submitted By field.
This is an optional field that is intended for the name of the
person entering the order.
- Select the Surgeon/Physician.
Choose a surgeon/physician.
- If desired, enter a comment in the Order comment field. This is an optional field that allows
letters, numbers, punctuation, and spaces.
- Select the Specimen Type. Choose a
specimen type (Biopsy, Cystectomy Partial Cystectomy Total,
Excision, Nephrectomy Partial, Nephrectomy Total, or TURBT).
Note: The selection made
in this field will appear in the Specimen Description field above.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
- Select the Laterality. Choose a
laterality of either Left or Right.
Note: The selection made
in this field will appear in the Specimen Description field above.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
- Select the Submission Type. Choose
a submission type (Fresh, Fixed, or Intra-Op Consult).
Note: The selection made
in this field will appear in the Specimen Description field above.
Note: If Fresh or Intra-Op Consult is selected, the Urgency field will change to STAT;
you will receive a Warning dialog regarding the change.
Note: If you change the Submission Type to Fixed on all of the specimens (whether only one specimen on
the order or multiple specimens on the order), you will need to manually change
the Urgency to Routine if that is desired.
- If desired, enter a
description for the specimen in the Specimen
Description field. This is a required field with a maximum character
length of 75 which includes letters, numbers, punctuation, and
spaces.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
Note: If you delete a
specimen and there are multiple specimens, the specimen numbers will be
reordered in the Specimen Description list.
- Select the Clinical History
tab. Enter the patient’s history in
the Clinical History field. This is a required field that allows letters,
numbers, punctuation, and spaces.
- Select the Pre-Operative
Diagnosis tab. Enter the
patient’s pre-operative diagnosis in the Pre-Operative Diagnosis field.
This is a required field that allows letters, numbers, punctuation, and
spaces.
- If desired, select the Operative
Findings tab. Enter the
patient’s operative findings in the Operative Findings field. This is an
optional field that allows letters, numbers, punctuation, and spaces.
- If desired, select the Post-Operative
Findings tab. Enter the
patient’s Post-Operative Findings. This is an optional field that allows
letters, numbers, punctuation, and spaces.
- Select Accept Order.
- Preview the order.
- If desired, modify the order by selecting the Back button, or select the Accept Order button to accept the order.
- If desired, enter another lab test. -or-
Select Accept Order.
-or-
Select Quit.
Note: The Lab Test order
must be signed before it is sent to VistA to be accessioned and processed. You
can either sign the order now or wait until later.
Entering a Urology, Prostate Lab Test
To place an order for a
Urology, Prostate lab test, follow these steps:
- Select the Orders
tab.
- Select Anatomic
Pathology from the Write Orders
list.
Note: The orders listed
in the Write Orders pane vary from site to site.
- If the patient is an outpatient, select a Visit Location in the Location
for Current Activities box and choose a visit location.
- Choose the Date/Time of
the visit.
- Select OK.
- Select Urology,
Prostate in the Available Lab Tests list box.
Note: The
dialog displayed will change based upon the specimen selected. The dialog shown below will display when
either Left Testis or Right Testis is selected as a specimen.
Urology, Prostate dialog
- Select the Specimen Description on the left side of the dialog box. Choose a specimen description. If this is the first specimen, use the + key located above the Specimen
Description field. Use the
drop-down list for subsequent specimens.
Note: At least one
specimen along with a specimen description is required to process an
order.
- If desired, change the default values for Urgency and/or Collection
Date/Time fields. These are required fields.
- If desired, enter your name in the Specimen Submitted By field.
This is an optional field that is intended for the name of the
person entering the order.
- Select the Surgeon/Physician. Choose a surgeon/physician.
- If desired, enter a comment in the Order comment field. This is an optional field that allows
letters, numbers, punctuation, and spaces.
- Select the Specimen Type. Choose a
specimen type (Left Testis, Prostate, Right Testis, or Vas
Deferens).
a.
When Left Testis or Right Testis
is selected as a specimen, select Specimen
Type. Choose a specimen type of Orchiectomy. The Urology, Prostate dialog when either Left
Testis or Right Testis is selected as a specimen will display as shown below.
Left Testis (or Right Testis)
selected as a specimen
b.
When Prostate is selected as a specimen, select Specimen Type. Choose a
specimen type (Prostate Needle Biopsy,
Prostatectomy, Radical Prostatectomy, Simple
Resection, Orchiectomy, TURP or Vasectomy). The Urology,
Prostate dialog when Prostate is selected as a specimen will display as shown
below.
Prostate selected as a specimen
c.
When Vas Deferens is selected as a specimen, select Specimen Type. Choose a
specimen type of Vasectomy. The Urology, Prostate dialog when Vas
Deferens is selected as a specimen will display as shown below.
Note: The selection made
in this field will appear in the Specimen Description field above.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
Vas Deferens selected as a specimen
- Select the Submission Type. Choose
a submission type (Fresh, Fixed, or Intra-Op Consult).
Note: The selection made
in this field will appear in the Specimen Description field above.
Note: If Fresh or Intra-Op Consult is selected, the Urgency field will change to STAT;
you will receive a Warning dialog regarding the change.
Note: If you change the Submission Type to Fixed on all of the specimens (whether only one specimen on
the order or multiple specimens on the order), you will need to manually change
the Urgency to Routine if that is desired.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
- If desired, enter a description for the
specimen in the Specimen
Description field. This is a required field with a maximum character
length of 75 which includes letters, numbers, punctuation, and
spaces.
● If desired, select the X
button to delete the entry. Deleting the
entry will result in a CPRS Patient Chart Warning dialog box; select the Yes button to confirm the deletion or
select the No button to cancel the
deletion.
Note: If
you delete a specimen and there are multiple specimens, the specimen numbers
will be reordered in the Specimen Description list.
- Select the Clinical History tab.
Enter the patient’s history in the Clinical History field. This is
a required field that allows letters, numbers, punctuation, and spaces.
a.
Select Applicable History. Enter
the patient’s applicable history (Abnormal
DRE, Increased PSA, or Prostate Cancer).
- Select the Pre-Operative
Diagnosis tab. Enter the
patient’s pre-operative diagnosis in the Pre-Operative Diagnosis field.
This is a required field that allows letters, numbers, punctuation, and
spaces.
- If desired, select the Operative
Findings tab. Enter the
patient’s operative findings in the Operative Findings field. This is an
optional field that allows letters, numbers, punctuation, and spaces.
- If desired, select the Post-Operative
Findings tab. Enter the
patient’s Post-Operative Findings. This is an optional field that allows
letters, numbers, punctuation, and spaces.
- Select Accept Order.
- Preview the order.
- If desired, modify the order by selecting the Back button, or select the Accept Order button to accept the order.
- If desired, enter another lab test. -or-
Select Accept Order.
-or-
Select Quit.
Note: The Lab Test order
must be signed before it is sent to VistA to be accessioned and processed. You
can either sign the order now or wait until later.
Radiology and Imaging
The Reason for Study and the Clinical History fields are now
two separate entries. Developers made this change to support a new system. The
Reason for Study field is now required and has a limit of 64 characters
(numbers, letters, space, and punctuation). The Clinical History field is
optional and has no character limit.
To order any type of imaging, such as an x-ray or a nuclear
medicine exam or procedure, follow these steps:
- Select the Orders tab.
- Select the active orders view from the View Orders pane -or- select
View | Active Orders (includes pending, recent activity).
- Select Imaging in the Write Orders list
box.
Note: The imaging order may
be labeled differently or may not be available from your Write Orders field.
The Order an
Imaging Procedure dialog displays as shown below.
Order an Imaging Procedure dialog
Note: If encounter
information has not been entered, the encounter information dialog will appear
before the Order an Imaging Procedure dialog. You must complete the encounter
information dialog before proceeding.
- Select the desired imaging type in the Imaging Type field.
- Select a procedure from the Imaging Procedure list box.
- Select an available modifier from the
Available Modifiers field.
The modifier(s) you select will be
displayed in the Selected Modifiers field.
Note: You can remove a
modifier by selecting the modifier and clicking Remove.
- Enter a reason for the exam in the Reason for Study field. (This is
a required field that allows a maximum of 64 characters—which includes
letters, numbers, punctuation, and spaces.)
- (Optional) If wanted, enter the history in the Clinical History
field (If you enter anything, it must be at least two consecutive
alphanumeric characters).
- If necessary, change the Requested Date,
Urgency, Transport, and Category fields.
Note: The Date Desired
previously defaulted to TODAY, but this default has been removed from most
orders. The user will need to enter the Date Desired.
- Complete the Submit To field (if necessary).
- Check the Isolation checkbox (if necessary).
- Select the appropriate response (Yes, No, or Unknown) in the
Pregnant field.
- Select the time that the PreOp is scheduled by doing one of the
following:
o
entering a date (e.g.
6/21/01 or June 21, 2001)
o
entering a date
formula (e.g. t-200)
o pressing the button to bring up a calendar
- Select Accept Order.
- Enter another order -or- click Quit.
Requesting a Return Clinic Appointment
As part of the effort to improve access to VA healthcare,
the Vista Scheduling Enhancements (VSE) project was initiated. The project
makes several enhancements involving scheduling appointments, including the
ability to create an order in CPRS that is sent to Scheduling so that a clerk
can schedule one or more appointments for a patient to return to a clinic for
additional visits.
Note: The Return to Clinic dialog will only be
accessible if the new Scheduling enhancements are in place, which will be
released in patch SD*5.3*671. CACs can create Quick Orders and add the Return
to Clinic Order Dialog to any menu before the SD patch is installed. If a user
tries to access the Return to Clinic Order Dialog before the SD patch is
installed, they will see an error message in CPRS stating the Order Dialog
cannot be use until the SD patch is installed.
The Return to Clinic dialog has several fields that enable
the user to specify the details related to the patient returning for one or
more appointments:
Quick Orders: This
field lists any personal quick orders that the user has already saved for
himself or herself. To create Return to Clinic personal quick orders, enter all
the necessary data in the Return to Clinic order dialog, but do not select
Accept yet. Then, save it as a Personal Quick Order.
Clinic: The
clinic the patient should return to
Date: The date
the patient should return to the clinic
Time Sensitive:
Whether the appointment is Time-Sensitive
● Not Time Sensitive: If the appointment is not
time-sensitive, the order will read “on or around.”
● Time Sensitive: If the appointment is Time Sensitive, the
order text will read “no later than.”
Number of
Appointments: Providers enter the number of future appointments they would
like to request. The number of return appointments is limited to 60.
Interval in day(s):
Note that this field is only available when the number of appointments is
greater than 1. Providers can enter the number of days between appointments.
For example, a provider may want to request a number of appointments 14 days
apart. The maximum interval is 30 days.
Prerequisites (check
all that apply): This item is available only if the site puts items into a
parameter where prerequisites are defined. For example, if nothing is put in
the parameter, the user will not have any selections in this field. However, if
the site puts in labs or radiology, the provider can select as many of those
items as apply.
Comments: This is
where the user can enter their own comments for the scheduler to see.
More Information:
This field displays information to the user while they are creating the order.
This is information entered by the site, not by the provider.
Order Sig: This
field is created as information is entered into the dialog by the user.
This
shows the Return to Clinic order dialog. Note that if the site does not enter prerequisites,
none will display where the above dialog displays the Labs, Vitals, and Imaging
choices. The More Information field also has data only if the site enters
information in a parameter
To order one or more
return visits to a clinic, use these steps:
- On the CPRS Orders tab under the Write Orders pane, select Return
to Clinic.
- In the Return to Clinic dialog, if you have saved a Quick Order
that you would like to use, select the down arrow and then select the
quick order. If not, proceed to step 3.
- Select the Clinic field’s drop-down box’s arrow and then the
appropriate clinic name. (This is a required field.)
- In the Date field, select the date. (This is a required field.)
- If the appointment is time-sensitive, select the Time Sensitive
check box. Selecting the Time Sensitive check box will change the order
text in the Order Sig from “on or around” to “no later than.”
- If you want more than one appointment, place the cursor in the
Number of Appointments field, enter the number of appointments.
- In the Interval in day(s) field, enter the number of days between
appointments.
- If the field is active, you can select the Prerequisites field, you
can select one or more prerequisites, such as lab work or imaging, that
should precede the appointments.
- In the Comments field, type in any comments that should go with the
orders.
- In the More Information field, additional information displays for
the user to see.
- Review the Order Sig to ensure that it is
as you need it.
Note: If the
order is one that the user will reuse frequently, the user can save it as a
personal quick order. To save this as a quick order, go to the menu bar and
select Options | Save as Personal Quick Order.
Then, the order will display in the Quick order field the
next time the dialog is opened.
- If the Order Sig is correct, select Accept.
After the user signs the order, the
order is sent to Scheduling so that a clerk can make the requested
appointments.
Here is an example of an unsigned Return to Clinic order
displayed on the Orders tab. The display shows a Return to Clinic order under
the new Service category of Clinic Scheduling.
Note: If the
provider has an NPI, it will not display on the screen below.
Clinic Scheduling orders can have the following statuses:
●
Unreleased: The order
will have this status before it is signed.
●
Pending: The order
will have this status after it is signed but before being acted upon by the
Scheduling package.
●
Completed: The order
will have this status after Scheduling has acted up on it.
●
Discontinued: The
order will have this status if the order is discontinued in CPRS prior to being
acted upon by the Scheduling package.
After the Clinic Scheduling order is signed, if the user
right-clicks on the order, only two items will be available: Discontinue and
Change. This is different from medications orders, for example.
This capture shows the detailed display for a Return to
clinic order.
Note: If the provider has an NPI, it will not
display on the screen above.
Ordering a Consult
To order a consult from the Orders tab follow these steps:
- Select the Orders tab.
- Select the active orders view from the View
Orders pane
-or-
select View | Active Orders (includes pending, recent activity).
- Select Consult in the Write Orders list.
Note: The consults order
may be labeled differently or may not be available from your Write Orders
field.
Note: If encounter
information has not been entered, the encounter information dialog will appear
before the Order a Consult dialog. You
must complete the encounter information dialog before proceeding.
The Order a
Consult dialog displays as shown below.
The Order a Consult dialog
- Select a type of consult from the Consult
to Service/Specialty field.
When you select
the Consult Service or Specialty, several things may happen:
o
If the service has
some prerequisites, a dialog will display stating what those are and will allow
you to print the information, continue to place the consult order, or cancel
the order.
o
In addition, any
predefined text or template will display to help the user fill out the Reason
for Request field.
o
The Provisional
Diagnosis field becomes active as well.
- Select the urgency from the Urgency field.
- Select an individual from the Attention
field.
Note: To help you distinguish between providers, CPRS displays their
titles (if available). When two or more providers have identical names, CPRS
also displays:
o The service/section and
site division (if any) associated with these providers; site divisions are
displayed based on the following rules:
▪ When no division is listed for a provider, no division is
displayed.
▪ If only one division is listed, this division is displayed.
▪ If the site has multiple divisions or more than one
division is listed and one of these
listed divisions is marked as Default, CPRS displays the division marked as
Default.
▪ If more than one division is listed for a provider and none
is marked as Default, CPRS does not display division information for this
provider.
o Providers who are listed in the New
Person file as Visitors are screened out from the provider list. (These
screened-out providers are listed as Visitors because their entries were
created as a result of a Remote Data View.)
- If needed, designate a different Clinically
Indicated Date.
Note: The Clinically Indicated Date field does not apply to
Prosthetics consults services, and the field is not available when the user
selects a Prosthetic service.
- Choose inpatient or outpatient from the “Patient will be seen as
an:” option group.
- Choose a location from the Place of Consultation drop-down box.
- Enter a provisional diagnosis.
Note: If a user tries to
enter a diagnosis with an inactive code, CPRS will bring up a message
indicating that the code must be changed and giving the user the chance to
choose a diagnosis with an active code.
For each consult, this field is
either set up to require that
● The user type in an answer (the box will be white and the
● Lexicon button unavailable), or
● The user must select a response must be from the Lexicon
(the field will be yellow and the Lexicon button is available).
CPRS will search for diagnoses that
contain the search term. The matching terms will display in the bottom portion
of the Problem List Lexicon Search dialog. The search now looks for SNOMED
Concepts Terms (SNOMED CT) items. Most items will also be mapped to an ICD-9-CM
code. The list will show the SNOMED concept text, the SNOMED code, and the
ICD-9-CM code if the term is mapped to one.
If you do not see the appropriate
problem listed, select the Extend Search button. The Extend Search button
extends the search to the ICD-9-CM clinical hierarchy to find additional
terms.
- Enter a reason for the request in the
Reason for Request field.
Sites can help users by putting in
predetermined boilerplate text, text with TIU objects, and/or it could be
linked to a template that users can fill out. Users can then add to the text
already present. Or the field may be left blank for the user to fill in the
reason. However, a reason for request is required and the consult cannot be
saved without a reason for request.
- Select Accept Order.
- Enter another Consult
-or-
select Quit.
Note: You may sign the
consult now or wait until later.
Procedures
To order a procedure, follow these steps:
- Select the Orders tab.
- Select Procedure in the Write Orders list.
Note: The procedure order may be labeled
differently or may not be available from your Write Orders list box.
Note: If encounter information has not been
entered, the encounter information dialog will appear before the Order a
Procedure dialog. You must complete the
encounter information dialog before proceeding.
The Order a Procedure dialog displays.
The
Order a Procedure dialog
- Locate and select the procedure in the
Procedure list.
When you select the Consult Service or Specialty, several
things may happen:
● If the service has some prerequisites, a dialog will
display stating what those are and will allow you to print the information,
continue to place the consult order, or cancel the order.
● In addition, any predefined text or template will display
to help the user fill out the Reason for Request field.
● The Provisional Diagnosis field becomes active as
well.
- Select the urgency from the Urgency field.
- Select an individual from the Attention
field.
Note: To
help you distinguish between providers, CPRS displays their titles (if
available). When two or more providers have identical names, CPRS also
displays:
●
The service/section
and site division (if any) associated with these providers; site divisions are
displayed based on the following rules:
o
When no division is
listed for a provider, no division is displayed.
o
If only one division
is listed, this division is displayed.
o
If the site has
multiple divisions or more than one division is listed and one of these listed divisions is marked as Default, CPRS
displays the division marked as Default.
o
If more than one
division is listed for a provider and none is marked as Default, CPRS does not
display division information for this provider.
● Providers who are listed in the New Person file as Visitors
are screened out from the provider list. (These screened-out providers are
listed as Visitors because their entries were created as a result of a Remote
Data View.)
- If needed, designate a different Clinically
Indicated Date.
Note: The Clinically Indicated Date field does not
apply to Prosthetics consults services, and the field is not available when the
user selects a Prosthetic service.
- If necessary, select a service that will
perform the procedure by using the down arrow to open the list and then
selecting the service.
Often, the service is already
defined. However, sometimes, the user has the chance to choose.
- Select whether the patient is an inpatient or outpatient.
- Select a place of consultation from the Place of Consultation
drop-down list.
- Enter a provisional diagnosis in the
Provisional Diagnosis field.
For each procedure, this field is
either set up to require that
● the user type in an answer (the box will be white and the
Lexicon button unavailable), or
● the user must select a response must be from the Lexicon
(the field will be yellow and the Lexicon button is available).
● CPRS will search for diagnoses that contain the search
term. The matching terms will display in the bottom portion of the Problem List
Lexicon Search dialog. The search now looks for SNOMED Concepts Terms (SNOMED
CT) items. Most items will also be mapped to an ICD-9-CM code. The list will
show the SNOMED concept text, the SNOMED code, and the ICD-9-CM code if the
term is mapped to one.
● If you do not see the appropriate problem listed, select
the Extend Search button. The Extend Search button extends the search to the
ICD-9-CM clinical hierarchy to find additional terms.
Note: If a user tries to enter a diagnosis with an
inactive code, CPRS will bring up a message indicating that the code must be
changed and giving the user the chance to choose a diagnosis with an active
code.
- Enter a reason for this request in the
Reason for request field.
Sites can help users by putting in
predetermined boilerplate text, text with TIU objects, and/or it could be
linked to a template that users can fill out. Users can then add to the text
already present. Or the field may be left blank for the user to fill in the
reason. However, a reason for request is required and the consult cannot be
saved without a reason for request.
- Select Accept Order.
- Enter another order -or- select Quit.
Note: The order must be signed before it is sent.
You can either sign the order now or wait until later.
Vitals
This section gives steps to place an order directing staff
to collect vitals with a certain frequency over a time period. To record vitals
and measurements, staff should use the new Vitals package or the Vitals Lite
interface in CPRS.
To enter a vitals order, follow these steps:
1.
Select the Orders tab.
2.
Select the active
orders view from the View Orders pane
-or-
select View | Active Orders (includes pending,
recent activity).
3.
Select Vitals in the Write Orders list box.
The VITAL SIGNS dialog appears.
Note: The vitals order may
be labeled differently or may not be available from your Write Orders list.
The VITAL SIGNS dialog box
Note: If encounter
information has not been entered, the encounter information dialog will appear
before the VITAL SIGNS dialog. You must
complete the encounter information dialog before proceeding.
4.
Select a vital sign
from the Vital Sign drop-down list.
5.
Select a date and time
from the Start Date/Time field by doing one of the following:
●
entering a date (e.g.
6/21/01 or June 21, 2001).
●
entering a date
formula (e.g. t-200).
●
pressing the button to bring up a calendar.
6.
Enter a schedule in
the Schedule field.
7.
Select a stop date and
time from the Stop Date/Time field by doing one of the following:
●
entering a date (e.g.
6/21/01 or June 21, 2001).
●
entering a date
formula (e.g. t-200).
●
pressing the button to bring up a calendar.
8.
Enter any special
instructions in the Special Instructions field.
9.
Select Accept Order.
Text Only Orders
Text only orders such as Parameters, Activity, Patient Care,
and Free Text orders are different kinds of orders that are placed for nursing
and ward staff to take action on. They print only at the patient’s
ward/location, and are not transmitted electronically to other services.
Examples of text only orders include:
|
Order Type
|
Order
|
|
Parameters
|
Vital signs
|
|
Activity
|
Bed rest, ambulate, up in chair
|
|
Patient Care
|
Skin and wound care, drains, hemodynamics
|
|
Free text
|
Immunizations
|
Predefined nursing orders (quick orders) may be available
under various submenus.
To place a text only order, follow these steps:
- Select the Orders tab.
- Select the active orders view from the View Orders pane.
- Select Text Only Order in the Write Orders
list box.
The Word Processing Order dialog
displays.
Note: The text only order
may be labeled differently or may not be available from your Write Orders list.
The Text Only Order dialog
- Enter the text for the order in the Order field.
- Enter a start date and time by doing one of the following:
o
entering a date (e.g.
6/21/01 or June 21, 2001).
o
entering a date
formula (e.g. t-200).
o
pressing the button to bring up a calendar.
- Enter a stop date and time by doing one of the
following:
o
entering a date (e.g.
6/21/01 or June 21, 2001).
o
entering a date
formula (e.g. t-200).
o
pressing the button to bring up a calendar.
- Select Accept Order.
- Enter another order
-or-
select Quit.
Event-Delayed Orders
An event-delayed order is an order that is executed only
after a predefined event (known as a release event) occurs. A release event can
be an event such as an admission, discharge, or transfer. For example, you can write an event-delayed
diet order that will not execute until a patient is transferred to a specific
ward.
A CAC defines the release events at your site. (For more information on defining release
events, see Appendix F of the CPRS List
Manager Technical Manual or the Event-Delayed Orders topic in the CPRS GUI Technical Manual). Once a CAC has defined a release event, you
can write an order that will not execute until that release event occurs.
Writing an Event-Delayed Order
To write an event-delayed order, follow these steps:
- Select the Orders tab.
- Select the Write Delayed Orders button
located below the View Orders pane.
The Release Orders dialog box appears.
The available release events will appear in a list. Your list may contain a highlighted default
release event and a common release event list.
Your CAC defines the default release event and the common release event
list. (For more information about defining a default release event and a common
release event list, please see the Event-Delayed Orders topic in the CPRS GUI Technical Manual or Appendix F
in the CPRS List Manager Technical Manual).
Your CAC can define a default release
event and a common release event list
- Select Delay Release of New Order(s) until.
- Select the appropriate release event.
Note: If the patient’s
location has a treating specialty of “observation” and the user tried to write
delayed orders, the “transfer” event should not appear in the selection list.
The reason is that orders are discontinued on transfer. The result would be if
a patient were in an observation location, and delayed orders were written when
the patient was moved out of observation, the orders would be cancelled.
- Select OK.
If the Copy active orders for selected event dialog box appears, continue
to step 5. Otherwise, the Release Orders
dialog will close and the name of the release event will now appear below the
Write Delayed Orders button. Enter the order as you normally would.
Note: If the provider has an
NPI, it will not display on the screen below.
The Copy active orders for selected
event dialog box
- Select the active orders that you would like to delay in the Copy
active orders for selected release event dialog box. These orders will be
delayed until the release event specified at the top of the dialog occurs.
You can press and hold Shift to select a range of orders or you can press
and hold ctrl to select multiple individual orders.
- Select OK.
The Ordering Information dialog box appears. This dialog contains the
release event that you have selected. Make sure that you selected the correct
release event.
- Select OK.
- Enter the order as you normally would.
Note: If the provider has an NPI, it
will not display on the screen below.
The name of the release event
appears below the Write Delayed Orders button and above the list of orders
Assigning/Changing the Release Event
If an order is not signed, you can change the order’s
current release event or assign a release event to a regular order. However,
once an order has been signed, you cannot make further changes.
To assign or change a release event, follow these steps:
- Select the Orders tab.
- Select the type of order you would like to
change from the View Orders pane.
The orders for the type you select
will be displayed in the details pane on the right side of the screen.
- Highlight the order you would like to change from the details pane.
- Select Action | Change Release Event
-or-
right-click on the order and
select Change Release Event from the
right click menu.
The Change Release Event dialog box displays. The current release event
will be highlighted.
The current release event is
highlighted in the Change Release Event
dialog
Note: If the release event
cannot be changed, the Unable to be
Released to Service dialog box appears. The reason that the release
event cannot be changed is listed at the bottom of the dialog box. Press OK to
close the dialog box.
This dialog box will appear if an
order’s release event cannot be changed
- To change the release event, select another
event and click Change. To simply remove the existing event, click
Remove.
A confirmation dialog appears.
- Click OK to confirm your changes.
Manually Releasing an Event-Delayed Order
Note: Each site can set a parameter that determines
if the user must hold a key or if a parameter setting will determine which
users can release delayed orders.
To release an event-delayed order manually (before the
release event occurs), follow these steps:
- Select the Orders tab.
- Select the type of order you would like to release from the View
Orders pane.
- The corresponding orders will appear on the right side
of the screen.
- Highlight the order you would like to release from the details pane
on the right side of the screen.
- Select Action | Release Delayed Orders
-or-
right-click on
the order and select Release Delayed
Orders.
Note: You
must sign an order before it can be released.
The Release to
Service dialog box will appear.
- Review the orders you wish to release and select OK.
- If the Print Orders dialog box appears,
select the appropriate prints and devices and press Print All Checked
Items or Print Highlighted Items Only.
Viewing an Event-Delayed Order after It Is Released
To view an event-delayed order after it has been released,
follow these steps:
- Select the Orders tab.
- Select View | Auto-DC/Release Event Orders
The Auto-DC/Release Event Orders
dialog appears.
- Choose the event the order is associated with.
- Select OK.
The appropriate orders will appear
on the Orders tab.
Notifying a User when Order Results Are Available
To notify a user when the results of an order are available,
follow these steps:
- Select the Orders tab.
- Select the desired type of order in the View Orders list box.
- Select an order from the list of orders on the right-hand side of
the screen.
- Select Action | Alert when Results....
The Alert when Results dialog
displays.
- Choose an alert recipient from the Alert
Recipient drop-down field.
Note: A recipient must have
the ORDERER-FLAGGED RESULTS notification/alert enabled in order to receive the
alert.
- Select OK.
Flagging an Order
With CPRS, users can flag an order to
draw attention to it. When an order is flagged, the word “Flagged” will appear
in the Orders column and the Service or Event column for the flagged order
displays red. Below some points about flags are further explained.
●
Multiple recipients: CPRS enables users to send the flag to
multiple individuals. The user flagging the order can choose from a list of
possible recipients and those recipients will receive an alert that the order
has been flagged.
Note: A recipient must
have the FLAG ORDER FOR CLARIFICATION notification/alert enabled to receive the
alert.
●
No Action Alert: The user flagging the order can also
check the No Action Alert checkbox to receive an alert if none of the
recipients acts on the flag before the specified time. When the user checks the
No Action Alert checkbox, the time in the field is the default time that is
controlled by a parameter. Your site can set a default time or leave it empty.
If the sites do not enter a default time, the default time is 24 hours.
However, the site can set the default time to a different amount of time, such
as 8 hours, or 4 hours, or whatever your site chooses. But, when the user
checks the No Action Alert, the user can change the time.
●
Flag Information in Order Details: CPRS records the name of the person who
flagged the order and the date and time that it was flagged. CPRS also tracks
comments on the flag and who unflags an order with the date and time.
●
Reason for Flag when Processing: When the user processes the order, CPRS
displays the reason for the flag in the order text on the Orders tab.
To flag an order, use
these steps:
- Select the Orders tab.
- Select the desired type of orders in the View Orders list box.
- Select the individual order that you would
like to flag from the list of orders on the right side of the screen.
- Select Action | Flag....
The Flag Order dialog displays.
The Flag Order dialog with the red
rectangle added showing that multiple providers can be added as
recipients.
- Enter a reason for the flag in the Reason for Flag field. Users can
choose a reason from the drop-down list, choose a reason and add
additional text, or enter their own text. The Reason for flag field has a
240-character limit.
- Choose alert recipients from the Alert
Recipient drop-down field. To locate names, type part of the name and the
list will scroll and you can select the right name and move the name to
the recipient pane on the right. Repeat the process until you have all the
names you want in the recipient pane on the right.
Note: A recipient must have
the FLAG ORDER FOR CLARIFICATION notification/alert enabled to receive the
alert.
- If you want to receive an alert if no one acts on the flag, check
the Create a No Action Alert
check box.
- Enter the time after which you want to receive the alert. You can
accept the default and move to the next step. Or you can set the time you
want by selecting the button with three dots to bring up the Calendar
component and select a date and time, then move to the next step.
- Select OK.
Note: If the OR FLAGGED
& WARD COMMENTS parameter is turned On, flagged Order comments and Ward
comments will display directly in the Order column. This parameter is turned
Off by default; a CAC must activate it for your site. Refer to the CPRS Technical Manual: GUI Version for
details on how to activate this parameter.
Note: If the provider has an NPI, it
will not display on the screen below.
CPRS Orders tab with a flagged order
comment displayed in the Order column
Unflagging an Order
CPRS has enabled sites to restrict which users can unflag an
order.
For a user to unflag an order, the user must meet one
of the requirements:
● the user is assigned the ORES key
● the user is assigned another security key that the
site designates (the sit can determine which keys can unflag orders)
● the user who flagged the order
● the user is a flag order recipient
If a user tries to unflag an order, but does not have the
correct key, the following error message will display:
You are not allowed to unflag this order based on your
security keys and the order type.
Note: The above
message is the standard message. Sites can also add their own text if they
choose.
If the user has the right security key, the user
can remove the flag from an order very simply. The user must enter a reason for
removing the flag (the reason must be a minimum of 4 characters, or the OK
button will be disabled).
In the order's detailed display, CPRS
will record the name of the person who removed the flag, the reason entered for
removing the flag, and the date and time that person removed it.
To unflag an order, use these steps:
- Select the Orders
tab.
- Select the order you want to unflag.
- Select Action | Unflag.
- Enter a reason (must be at least 4 characters).
- Select OK.
Overview of CPRS/POE Functionality
To make it easier for providers to enter medication orders
and have fewer orders that need to be changed by pharmacy and returned for a
provider’s signature, the Pharmacy Ordering Enhancement (POE) project was
undertaken. The aim of this project was to make it easier for clinicians to
enter medication orders and have the computer do the work in the background to
provide pharmacists with the information they need to fill orders.
Ordering dialogs were redesigned in an attempt to reduce the
number of orders that need to be edited and returned for signature. Changes
include replacing the dispense drug prompt with a dose prompt, automatically
calculating the quantity of commonly dispensed drugs that are prescribed on
standard schedules, and providing more standard schedule options. With the new
ordering dialogs, CPRS uses an API to verify that the ordering provider has
been assigned a VA or DEA number when the provider attempts to order a
controlled substance. If the provider has not been assigned a VA or DEA number,
the provider is prevented from ordering the controlled substance.
In addition, a new tab for complex orders enables providers
to create complex doses for medications. The interface displays the expected
time of next administration and a check box enables you to place an order for
“Give First Dose Now.” (You must be careful, however, that the combination of
the NOW order and the original schedule do not overmedicate the patient.) In addition, another Medications item called
Medications may have been added to your ordering menu. The Medications item can
be used in addition to the existing dialogs for INPATIENT MEDS, OUTPATIENT
MEDS, and INFUSION. The only difference between this new dialog and the
Inpatient and Outpatient dialogs is that Medications will automatically assign
the ordering context (Inpatient vs. Outpatient) based on the selected patient's
current admission/visit status. The Medications item provides a single dialog
for medication orders instead of forcing the provider to pick among the
INPATIENT MEDS, OUTPATIENT MEDS, and INFUSION order dialogs. If the provider
wants to use those specific dialogs, they are still available.
Note: With the new Medications item, the provider
will not be able to write a prescription if the patient is currently admitted
or order an inpatient IV med for a patient in an outpatient clinic (i.e. you
won’t be able to write an order for the opposite context). Therefore, the old INPATIENT MEDS, OUTPATIENT
MEDS, and INFUSION items should still be available for the provider to use.
There are several other changes that are explained in the
POE Release Notes.
From the Notes tab you can create new progress notes for a
patient and view existing progress notes and documents. You can also create
templates to allow you to quickly and efficiently enter progress notes.
Documents on the Notes tab are organized in a tree structure on the left side
of the screen.
Group Notes
A new application called Group Notes enables authorized
users to write progress notes and enter encounter information for a group of
patients. Users can enter text and encounter information that applies to the
entire group of patients and then add information to individual patient’s notes
and encounters but sign all the notes at the same time.
Group Notes is a separate application from CPRS. Sites can
put an icon on the desktop or authorized personnel at the site can place an
item Tools menu. To use the Group Notes application, a user must be given a key
(OR GN ACCESS) and choose a location that allows group notes (set in the OR GN
LOCATIONS parameter). To find out more about Group Notes, please look for the
manuals under Group Notes on the VistA Documentation Library (http://www.va.gov/vdl/).
Once the notes are signed in the Group Notes application,
they are stored in TIU and displayed in CPRS like any other progress note.
Thus, they are not a different kind of note, but simply notes created in a way
that speeds text entry and signing for a group of patients that have the same
treatment or therapy while still allowing personalization of each note and
encounter for the patient.
Icons on the Notes Tab
The icons in front of the document titles on the Notes tab
help identify and categorize documents. A description of the icons is available
from the Icon Legend (shown below). To access the Icon Legend, click View | Icon Legend.
The
Icon Legend dialog box displays a description of the various icons in CPRS
Viewing Progress Notes
To view the text of a progress note, follow these steps:
- Select the Notes tab.
- Select a document title from the left side
of the screen. (Click the “+” sign to expand a heading.)
Note: If a note has an addendum, the 
icon will appear in front of the note title.
You may view the addendum by clicking the “+” sign to expand the note title and
then selecting the appropriate addendum.
The text of the progress note will
be displayed on the right side of the screen as shown below.
The list of notes for the selected
patient is displayed in the tree view on the left of the dialog. Above the tree
view, CPRS displays the sorting of the list (last 100 signed notes in this
case). Next to the label of the sorting, CPRS displays the total number of
notes the patient has. The text of a document is displayed on the right side of
the Notes tab
- (Optional) To view additional details of
the progress note, such as editing history, patient record flag links,
associated problems, select View | Details.
Note: If the provider has an
NPI, it will not display on the screen below.
This screen shows an example of a
progress note’s detailed display
To view all the
progress notes under a specific heading, follow these steps:
- Select the Notes tab.
- Double-click the heading that you would
like to view.
The notes that are related to that heading
will appear in a table on the right side of the screen.
- To view a specific note, select the note
from the table. You can also sort the table by clicking on the column you
wish to sort by (click the column again to sort the table in inverse
order).
Note: If a provider has an NPI, it will not display
on the screen below.
CPRS Notes Dialog viewing notes
under a specific heading
Customizing the Notes Tab
CPRS allows you to control which documents appear on the
Notes tab. From the View menu you can specify that only the following note
types appear on the tab:
•
All signed notes
•
Signed notes by a
particular author
•
Signed notes for a
particular date range
•
Uncosigned notes
•
Unsigned notes
In addition, you can use the View | Custom View
option to further customize the Notes tab.
Viewing All Signed Notes, All Unsigned Notes, or All
Uncosigned Notes
To view all signed notes, all unsigned notes, or all
uncosigned notes, follow these steps:
- Select the Notes tab.
- Select View | Signed Notes (All), View |
Uncosigned Notes, or View | Unsigned Notes.
The appropriate progress notes will
appear on the Notes tab.
If you would like to further limit the notes that are
displayed on the Notes tab, continue with the “Additional Customization” topic
(below).
Viewing All Signed Notes by a Specific Author
To view all signed notes by a specific author, follow these
steps:
- Select the Notes tab.
- Select View | Signed Notes by Author.
The List Signed Notes by Author
dialog displays.
Note: If the provider has an NPI, it will display on the screen
below. See the "National Provider
Identifier (NPI) Display in CPRS" section for an example of an NPI
displaying on a screen.
The List Signed Notes by Author
dialog
- Select the author of the note(s) that you would like to view.
- In the Sort Order option group, select Ascending (oldest first) to
view the oldest notes first, or Descending (newest first) to view the
newest notes first.
- Select OK.
The appropriate notes will appear
on the Notes tab.
If you would like to further limit the notes that are
displayed on the notes tab, continue with the “Additional Customization” topic
(below).
Viewing All Signed Notes for a Date Range
To view all signed notes by a specific author, follow these
steps:
1.
Select the Notes tab.
2.
Select View | Signed
Notes by Date Range.
The List Signed Notes by Date Range
dialog will appear.
The List Signed Notes by Date Range
dialog
3.
Enter a beginning date
by doing one of the following:
o
entering a date (e.g.
6/21/01 or June 21, 2001).
o
entering a date
formula (e.g. t-200).
o
pressing the button to bring up a calendar.
4.
Enter an ending date
by doing one of the following:
o
entering a date (e.g.
6/21/01 or June 21, 2001).
o
entering a date
formula (e.g. t-200).
o
pressing the button to bring up a calendar.
5.
Select OK.
The appropriate notes will be
displayed on the Notes tab.
Additional Customization
If you would like to further limit the notes that are
displayed on the Notes tab, follow these steps:
- From the Notes tab, select View | Custom
View.
The List Selected Documents dialog
will appear.
Note: If a provider has an
NPI, it will display on the screen below.
See the "National Provider Identifier (NPI) Display in CPRS"
section for an example of an NPI displaying on a screen.
The List Selected Documents dialog
- Select the criteria for the documents that
you want to display on the Notes tab by doing some or all of the
following:
Note: You cannot set all of
the fields at the same time. For example, if you choose one of the options for
“all notes,” then you are given the option of a date range because that
conflicts with the other choice.
a.
Select a status from
the left side of the window.
b.
Enter the maximum
number of notes that you would like to display in the Max Number to Return
field.
c.
Select an author or
expected cosigner from the Author or Expected Cosigner field.
d.
Select a beginning and
ending date by doing one of the following:
▪
entering a date (e.g.
6/21/01 or June 21, 2001)
▪
entering a date
formula (e.g. t-200)
▪
pressing the button to bring up a calendar
e.
Select a sort order
from the Note Tree View option group.
f.
If you would like to
group the notes, make a selection from the Group By drop-down list.
g.
If you would like to
further sort the notes that have been grouped in step f, select the criteria to
sort by in the Sort By drop-down list.
h.
If you would like the
subject of the notes to be displayed in the tree view, check the “Show subject
in list” check box.
i.
If you would like to
limit the notes that are displayed to notes that contain specific text in the
title or in the subject line, click the appropriate check box and enter the
text in the Contains field.
Note: You can erase the contents of the List Selected Documents
dialog by clicking the Clear Sort/Group/Search button.
- Click OK.
The notes that meet the criteria
you specified will appear on the Notes tab.
Improving the Tree View Custom
View Display
CPRS enables users to set a maximum
number of notes that should display when the Notes tab loads. The purpose of
defining a maximum number of notes is to avoid loading a large amount of
information that might slow performance. When there is a value in the Max
Number to Return field (2b above), CPRS has some additional features on the
tree view: a “Show More” item and another display category called “Older signed
notes with recent addenda”.
1)
Show More: If the user
has more notes available than the maximum allowed, a “Show More” entry displays
in the tree view. If the user double clicks “Show More”, CPRS downloads another
set of notes as the initial maximum. If
there are still more notes available, “Show More” appears again until there are
no more notes to display.
For example, if the selected patient has 300 total notes
and the Maximum Number of Notes is set to 30, when the Notes tab initially
opens, 30 Notes will be downloaded, and their information displayed in the tree
view. A Show More item will display at the end of the tree view because there
are more notes. If the user selects Show More, another 30 notes will be
downloaded and listed. If the user selects Show More again, another 30 notes
and the Show More item will display. This will continue until all the notes
have been listed.
2)
Older signed notes with recent addenda: Sometimes one or more notes outside the maximum range will
have an addendum inside the range. These notes are added to the bottom of the
list, under the date of the parent note.
In this example, the last two notes have recent addenda but are well
outside the range of the rest of the notes.
This makes it appear that there are no notes between the last normal
note (dated April 2019) and the older parent note with the recent addendum
(dated March 2009).
To prevent the appearance of a gap in notes, these older
notes are now separated from the rest of the notes after the “Show More” entry,
marked with the label “Older signed notes with recent addenda”.
As shown above, both Show More and Older signed notes with
recent addenda can be in the tree view.
Searching for Text (Within Current View)
CPRS can search for the exact text that users enter, search
the notes listed in the current view, and filter the tree view to display only
those notes that contain the exact text entered. Users should be careful to
enter text that will give them the desired notes. If users know the exact text,
this is simple. If they do not know the exact text, they will need to enter
something broad enough to bring up the desired notes.
For example, if the user knows that the exact text
“strangulated hernia” without the quotes, but with the space, is in the note,
the user can enter that exact phrase without the quotes and the appropriate
note should be found. However, if the user is uncertain of the exact text, the
user might want to search for “hernia” or even “hern” to ensure that the
appropriate notes will be found. This search would find words such as hernia,
herniated, etc.
To search for specific text in the current view, use these
steps:
- On the notes tab, select View | Search for Text (Within Current
View).
- In the List Signed Notes by Author dialog, enter the text for which
CPRS should search.
- Press OK.
CPRS will then search the current
view of notes and filter the tree view so that only those notes with the exact
text are displayed.
Setting a Default View
To set a default view for the Notes tab, follow these steps:
- Customize the Notes tab by following the steps above.
- Select View | Save as Default View.
A warning dialog will appear.
- Select OK.
The current view will be set as the
default view for the Notes tab.
Creating and Editing Progress Notes
To create a new
progress note, follow these steps:
- Select the Notes tab.
- Select the New Note button.
The Progress Note Properties
dialog displays.
Note: The encounter information dialog may appear
before the Progress Note Properties dialog if you have not entered encounter
information. If the encounter information dialog appears, enter the necessary
information and select OK.
Note: If the
provider has an NPI, it will display on the screen below. See the "National Provider Identifier
(NPI) Display in CPRS" section for an example of an NPI displaying on a
screen.
The
Progress Note Properties Dialog is where the user selects the progress note
title, date, author, and in the case of a consult or patient record flag note,
the consult number or patient record flag action for the note
- Select a title for the progress note from the Progress Note Title
drop-down list.
- If necessary, select a date and time for the progress note by doing
one of the following:
● entering a date (e.g. 6/21/01 or June 21, 2001)
● entering a date formula (e.g. t-200)
● pressing the button to bring up a calendar
- If necessary, select an author for the
progress note.
Note: To
help you distinguish between providers, CPRS displays their titles (if
available). When two or more providers have identical names, CPRS also
displays:
● The service/section and site division (if any) associated
with these providers; site divisions are displayed based on the following
rules:
o
When no division is
listed for a provider, no division is displayed.
o
If only one division
is listed, this division is displayed.
o
If the site has
multiple divisions or more than one division is listed and one of these listed divisions is marked as Default, CPRS
displays the division marked as Default.
o
If more than one
division is listed for a provider and none is marked as Default, CPRS does not
display division information for this provider.
●
Providers who are
listed in the New Person file as Visitors are screened out from the provider
list. (These screened-out providers are listed as Visitors because their
entries were created as a result of a Remote Data View.)
Note: Occasionally a problem occurs if a cosigner’s access lapses
and they have become "disusered". If this occurs, you can click OK
and proceed with that selection or click Cancel and choose another cosigner.
- If the note is to resolve a consult or to
document a patient record flag, select the consult number or the patient
record flag action to which the note should be linked. To help users
select the correct consult when a title that will resolve a consult is
selected and a consult is available to resolve, a Show Details button that
brings up the details of the consult is available.
Note: If the user attempts
to change the characteristics of a PRF note and has highlighted an action that
reads Yes under note, CPRS assumes that the user is trying to link to an
already linked action and will not allow the change to continue. However, if
the user removes the highlight from the Yes action, the changes can occur.
- Select OK.
- In the main text box, enter the content of the note using one or
more of the methods below:
● Copy and paste from other documents
●
Type in text
● Insert predefined text from templates.
a.
Select the Templates drawer.
b.
Locate the template
you need.
c.
Double-click the
template, drag-and-drop the template into the document, or right-click and
select Insert Template. (It will be placed where the cursor is.)
d.
Repeat steps b and c
as needed.
Note: If you need to view
the consult details while writing a note, bring up the popup menu by
right-clicking in the note editing pane and choosing View Consult Details or
using the shortcut Shift+Ctrl+U.
- After you enter the note, if you select
Encounter, you can enter encounter information for the visit.
Diagnosis, procedure, and Visit Type are required. The check
boxes are based on the Encounter Form defined for the Progress Note Title you
select. When you click on Other Diagnoses or Other Procedures, a Lexicon look
up (terms with their corresponding ICD or CPT codes) is displayed for you to
choose from.
Note: When finished, you
can continue working or select an item from the Action menu, such as Sign Note
Now..., Save Without Signature, or Add to Signature List.
To change a progress
note title, use these steps:
Note: Progress Notes can
only be edited if they have not been signed. Signed notes cannot be editing. To
add to a note, an addendum would have to be created.
- When in a note that you have already
started, select the Change… button.
The Progress Note Properties dialog
displays in which the user should select the note title, author, and date.
- Select the appropriate note title, author,
and/or date.
The Clear Previous Boilerplate Text
dialog displays as shown below.
- To keep the text in the note, select No. To
remove the text, select Yes.
To edit a progress note, follow these steps:
Note: Progress Notes can
only be edited if they have not been signed. Signed notes cannot be editing. To
add to a note, an addendum would have to be created.
- Select the Notes tab.
- Select a document title from the left side
of the screen. (Click the “+” sign to expand a heading.)
Note: If a note has an
addendum, the icon will appear in front of the note title.
You may view the addendum by clicking the “+” sign to expand the note title and
then selecting the appropriate addendum.
The text of the progress note will
be displayed on the right side of the screen.
- Select Action | Edit Progress Note…
You can now edit the progress note.
To find specific text
in a progress note, follow these steps:
- Select the Notes tab.
- Select a document title from the left side
of the screen. (Click the “+” sign to expand a heading.)
The text of the progress note will
be displayed on the right side of the screen.
Note: If a note has an
addendum, the icon will appear in front of the note title.
You may view the addendum by clicking the “+” sign to expand the note title and
then selecting the appropriate addendum.
- Right-click the text
of the progress note and select Find in Selected Note.
The Find dialog appears.
The
Find dialog allows you to replace text in a progress note
- Enter the text that you want to find.
Note: Check the Match whole
world only or Match case check boxes to search using these options.
- Select Find Next.
If the text is found, it will be
highlighted in the progress note.
- When finished, close the dialog.
To replace specific
text in a progress note, follow these steps:
Note: Users can edit only
unsigned progress notes. Once a note is signed, it cannot be edited.
1.
Select the Notes tab.
2.
Select a document
title from the left side of the screen. (Click the “+” sign to expand a
heading.)
The text of the progress note will
be displayed on the right side of the screen.
Note: If a note has an
addendum, the icon will appear in front of the note title.
You may view the addendum by clicking the “+” sign to expand the note title and
then selecting the appropriate addendum.
3.
Select Action | Edit
Progress Note….
4.
Right-click the text
of the progress note and select Replace
Text.
The Replace
dialog displays.
5.
Enter the text you
wish to replace in the Find what field.
6.
Enter the new text in
the Replace with field.
The Replace dialog allows you to replace text in a progress note
Note: Check the Match whole
world only or Match case check boxes to search using these options.
7.
Select either Find
Next, Replace, or Replace All.
If the text is found it will be
highlighted (if you selected Find Next) or changed (if you selected Replace or
Replace All).
Encounter Information
CPRS has two kinds of encounter information: visit
information and encounter form data.
For each visit (or telephone call) with a patient, you need
to enter the provider, location, date, and time. CPRS requires this information
before you can place orders, write notes, add to the problem list, and so on.
The parameter, ORWPCE ANYTIME ENCOUNTERS, can be set to
allow
encounters to be entered on the Notes tab when no note is
being entered. This will allow encounter entry (at the time of the visit) for
dictated notes. This parameter can be set at the User, Service, Division, and
System levels. Note that this will edit the encounter associated with the
current location and time, which is not necessarily the encounter associated
with the currently displayed note.
To receive workload credit, you must enter the encounter
form data, including the following information, for each encounter:
● Service connection
● Provider name
● Location
● Date
● Diagnosis
● Procedure
● Visit Information
CPRS shows the encounter provider and location for the visit
on the Visit Encounter box, identified in the graphic by the pointer. You can
access this box from any chart tab.
If a provider or location has not been assigned, CPRS will
prompt you for this information when you try to enter progress notes, create
orders, and perform other tasks.
Encounter Form Data
To get workload credit and gather information, enter
encounter form data whenever you create a progress note, complete a consult, or
write a discharge summary. When you create one of these documents, an Encounter
button appears. Click this button to bring up the Encounter Form. (Otherwise,
you will be prompted for encounter information when you try to sign the note or
exit the current patient’s chart.)
Note: If the
provider has an NPI, it will display on the screen below. See the "National Provider Identifier
(NPI) Display in CPRS" section for an example of an NPI displaying on a
screen.
The
Encounter Form
The Encounter Form has the following eight tabs:
● Visit Type
● Diagnoses
● Procedures
● Vitals
● Immunizations
● Skin Tests
● Patient Education
● Health Factors
● Exams
● Global Assessment of Functioning (GAF) (The GAF tab is
available only if specific Mental Health patches are installed and if the
location is a mental health clinic.)
Your site defines forms from the
Automated Information Collection System (AICS) application to be used with the
Encounter Form. Once your site has defined the necessary forms and associated
them with the Encounter Form, each tab has a number of general categories on
the left. When you click a general category, the corresponding items appear in
the list box on the right.
For example, the Visit Type tab might have New Patient,
Established Patient, and so on listed in the left list box. The list box on the
right would then have check boxes for the different types of patient
appointments, such as Brief Exam, Limited Exam, Intermediate Exam, Extended
Exam, and Comprehensive exam.
Even if you haven’t defined the form, you can click the
Other button to get a list of choices that are active on your system.
When the forms are defined and associated with the Encounter
Form, you can use the Encounter Form just as you would a paper form: just click
the appropriate tab, category, and check boxes to mark items or click Other and
select the appropriate choice. On the Visit Type tab, a provider can indicate
if the encounter is related to the various exemption categories, such as
Service Connected, Combat Veteran, Agent Orange exposure, Ionizing Radiation
exposure, Southwest Asia Conditions,
Shipboard Hazard and Defense, Military Sexual Trauma, and
Head and/or Neck Cancer. If these forms have not yet been defined, ask your
Clinical Coordinator for assistance.
Entering Encounter Form Data
In order to receive workload credit, you must enter
encounter form data when you create a new progress notes, complete a consult,
or write a discharge summary.
Note: Once a note, summary, or consult has been completed, you can
only change encounter information directly through Patient Care Encounter
(PCE.)
To enter encounter form data, follow these steps:
- Select the appropriate tab: Notes, Consults, or D/C Summ.
- Select New Note on the Notes tab, or locate the appropriate consult
or discharge summary. For the latter two, skip step 3.
- Type in a title for the note or summary or select one from the list
and press <Enter>.
- On the Notes tab, select the Encounter button, Action | Encounter,
or Edit Encounter Information from the right-click pop-up menu. On the
Consults and D/C Summ tabs, only the Edit Encounter Information item is
available on the pop-up menu.
- Select the tab where you want to enter
information (Type of Visit, where you can also enter the primary and
secondary providers, Diagnoses, where you can have diagnoses automatically
be added to the Problem List, Procedures, Vitals, Immunizations, Skin Tests,
Patient Ed., Health Factors, or Exams).
Note: To enter vitals, follow this manual’s instructions under Recording
Vitals.
- Click the appropriate category in the list
box on the left and then click the check boxes by the appropriate items in
the list box on the right. If the section name you want is not shown or
the list boxes are empty, use the search feature. To search, click on the
Other <Tab Name>. (Each tab’s button will be labeled differently.)
Locate and double-click the needed item. Some tabs have a simple list to
choose from. Diagnoses and Procedures have a search function. On these
tabs, you need to enter the beginning of a term and click Search before
double-clicking.
Note:
If a user tries to enter a diagnosis or procedure that has an inactive
code associated with it, CPRS will not accept that selection and will request
that the user change it. Also, although it is based on ICD-9-CM codes, the
Other Diagnosis… button will now search the SNOMED Concept Terms (SNOMED CT)
Problem List dataset, which should enable clinicians to better find the term
they need. If the list does not show the item you are looking for, you can
select the Extend Search button to search the ICD-9-CM file. All terms returned
by this search must map to ICD-9-CM codes so you may not see a code that has a
related SNOMED CT term and code, but you will see an ICD-9-CM code. If a
provider enters a diagnosis with or problem that has a 799.9 code (something
undefined), a notice will be sent to the Standards and Terminology Service and
a new mapping will be created. When available, the 799.9 code will
automatically be updated to the new code.
This screen shows a diagnosis on the
Encounter form with an inactive code
If a user selects a diagnosis or
procedure with an inactive code, the above dialog will display telling the user
that the code is inactive and that the user should change it
Note: The Type of Visit and Vitals tabs are different. Type of
Visit has no button, and Vitals has a Historical Vitals Details button that
brings up a dialog containing a graph and a listing of past vitals taken.
- Enter any additional information as
needed.
Several tabs have additional
features, such as drop-down lists for results of exams, severity of problems,
and so on.
- Fill in information for other tabs as needed by repeating steps
2-6.
- When finished, select OK.
Clinical Reminders
When a user opens a patient record, CPRS starts a job to
evaluate whether the patient has reminders that are due, available, etc. While
the evaluation is in process, a magnifying glass goes in a circle on the
Reminder button. When the magnifying glass stops, and a clock icon appears, the
reminders evaluation is complete.
You can find out if a patient has reminders by doing one of
the following:
•
Selecting the Reminders button near the top right of
the CPRS form. When you click this button, a dialog with a reminders tree view
will be displayed. The reminders button may display one of five icons. When it
displays a red clock, the patient has reminders due.
The Reminders button indicates
whether there are reminders for the current patient
•
Looking on the
coversheet that has an area specifically for reminders.
Note: If under Due
Date, the user sees Error or CNBD (which stands for “could not be
determined”), a problem occurred while the reminders were being evaluated. You
should contact your reminders coordinator.
•
Opening a reminders
drawer to check on the reminders for a patient after you have begun a new
progress note. When you click the Reminders
drawer, you will see a dialog with a tree view of due, applicable, and
other reminders.
The Reminders Drawer
After you begin a new progress note, you will see the
reminders drawer. If you click the drawer, a tree view of due, applicable, and
other reminders will be displayed. The
Due category automatically expands when you open the Reminders drawer, while
the Applicable and Other categories do not.
Note: Before you can process a reminder, a CAC or someone else must
create a dialog in a similar position at your site. A dialog image over the
clock or question mark icon shows that a reminder has an associated dialog.
After you process a reminder but before you reevaluate it, a
check is placed over the reminder to show it has been processed. Once you
reevaluate the reminder, it will be moved to the category for reminders that
are applicable but not due.
Click
a reminder to bring up the Reminders Processing dialog and process the reminder
Right-click a reminder to get the following options:
● Clinical
Maintenance—shows the possible resolutions
and the findings associated with the reminder.
● Education Topic
Definition—lists the education topics that
have been defined for a reminder. You can select a topic to view the desired
education outcome and any standards.
● Reminder Inquiry—shows the reminder definition describing which patients
are selected for this reminder.
● Reference
Information—lists Web sites with
additional information.
● Evaluate Reminder–tells you if a reminder is due, applicable or other.
● Reminder Icon
Legend–displays icon legend screen with
icons and meanings.
Each of these options brings up a window. When you are
finished with the window, click Close. For more information on Clinical
Reminders, refer to the Clinical
Reminders Manager Manual and Clinical
Reminders Clinician Guide.
Reminders Processing
You process Reminders using the Reminders Processing
dialog. The dialog displays the possible
activities that can occur during a visit and that can satisfy the reminder. You
may need to enter additional information.
If a Reminder dialog generates Primary Care Encounter (PCE)
data for the current encounter, the user is prompted to enter the primary
encounter provider when clicking the FINISH button, if one is needed (depending
on the PCE data created, and the setting of the ORWPCE DISABLE AUTO CHECKOUT
parameter).
In the reminder tree dialog, under the View menu, there are
now five new menu options for determining which folders will appear in the
reminder tree. These menu options, Due, Applicable, Not Applicable, All
Evaluated, and Other Categories, will be checked if that folder is to appear in
the tree. Individual users can set which folders will appear by selecting the
corresponding menu item.
The
Available Reminders dialog
When you check an item on a Reminder dialog, it may expand
to enable entry of more detailed information, such as dates, locations, test
results, and orders that you could place based on a response. The information
depends on how the dialog was created at your site. Reminder dialog elements
that allow only one choice per dialog group appear as radio buttons.
When you click a check box or item, the associated text that
will be placed in the progress note is shown in the area below the buttons.
Patient Care Encounter (PCE) data for the item is shown in the area below that.
Text and PCE data for the reminder that you are currently
processing are in bold.
When you
click the Finish button after entering vital signs in Reminder dialogs, a
prompt appears requesting the date and time the vital signs were taken. This
prompt defaults to the date of the encounter.
Reminder
Resolution dialog
● Required fields are no longer checked on a Reminder dialog
unless at least one entry has been made on the dialog. This allows users to
skip Reminders that are not intended for processing.
● Reminder dialog groups can now be set to NONE OR ONE
SELECTION, which allows up to one entry in a group, but does not require an
entry. PX*1.5*2 is required to change the reminder dialog definition.
● Required prompts and template fields will be marked with an
asterisk (*) to indicate that they are required. A message at the bottom of the
Reminder dialog states "* Indicates a Required Field."
Reminder dialogs have a Visit Info button. It opens a dialog
that allows the user to enter service-connected information, as well as the
vital sign entry date and time. If service-connected information is required
for the encounter and note title, this dialog automatically appears when you
click Finish.
Processing a Reminder
To process a reminder for a patient, complete the following
steps:
- If you have not already, begin a new progress note by clicking the
Notes tab, then New Note, and then select a note title. (If prompted,
enter the encounter location and provider.)
- Click the Reminders drawer or the Reminders button to open a tree
view of the reminders for this patient.
- Click the plus sign to expand the tree
hierarchy where needed and then click the reminder you will process. You
will then be presented with the dialog for processing reminders.
Note: If you click the Reminders
button, choose Action | Process Reminders Due to begin with the first reminder
due.
- Click the check boxes in front of the items that apply to this
patient, and enter any additional information requested such as comments,
diagnoses, and so forth.
- When you are finished with this reminder, click another reminder or
click Next to move to the next reminder.
- Repeat steps 4 and 5 as necessary to process the desired reminders.
- When you have processed all the reminders you want to process,
click Finish.
- Review and finish your progress note and
enter any information necessary in order dialogs.
Completing Reminder Processing
After you have entered all the information, you can finish
processing the reminders.
When you finish, the following things will happen:
● The predefined text is placed in the note you started to
write.
● The encounter information is sent to the Patient Care
Encounter (PCE) application for storage.
● If there are orders defined in the dialog, the orders will
also be created. If the orders require input, the order dialogs will appear so
that you can complete the orders. You must sign any orders that are created.
After you have signed the orders, click Finish
to finish processing remainders.
Using Mental Health Assessments in CPRS
When sites install CPRS v27 and the Mental Health dynamic
link library (YS_MHA.dll), mental health providers will have enhanced mental
health assessment tools. Mental health providers can use these tools through
Reminders in CPRS if the following have occurred:
● Several patches must be installed, including: YS*5.01*85
(which distributes YS_MHA.dll), PXRM*2.0*6, GMTS *2.7*77, and OR*3.0*243.
● YS_MHA.dll must be in the correct location.
● Users need to be assigned an additional secondary menu by a
Clinical Applications Coordinator (CAC) or similar individual who performs this
kind of set up at the site.
Document Templates
With the CPRS GUI, you can create document templates to make
writing or editing progress notes, completing consults, or writing discharge
summaries quicker and easier. In addition, you can import or export templates
and convert Microsoft Word files to document templates.
Locking Consult Templates
The Austin FSC Healthcare Claims Processing (HCP) Referral
& Authorization System (RAS) requested an enhancement to make a TIU
template used on a consult request as read-only. This action makes the template
and all its associated template fields unavailable for edit—they can be viewed
in the editors, but no values may be changed. RAS depends on specific text
elements appearing in certain consult templates. If these templates are
modified by a site, the messaging between RAS and VistA Consults/Request Tracking
can be disrupted.
These templates should not be edited by facilities and as
such will be locked during the installation of CPRS GUI v31b.
Template Editor
The Template Editor is used to create and manage document
templates. To access the Template Editor, select Options | Create New Template… from the Notes, Consults, or D/C Summ tab.
The
Template Editor window
For an explanation of the icons used
in the Template Editor, select Tools
| Template Icon Legend and click the
Templates tab.
The
Icon Legend
Personal and Shared Templates
You can create and use your own templates, or you can use
shared templates created by your Clinical Coordinator.
Personal Templates
Authorized users can create personal templates. You can copy
and paste text into a template, type in new content, add template fields, or
copy a shared template into your personal templates folder. A shared template
that you simply copy into your personal templates folder without changing
continues to be updated whenever the original template is changed or modified
in the Shared Templates folder. Once you personalize or change the copy of the
shared template in your personal templates field, the icon used to represent it
changes and it becomes a personal template. From that moment on, the personal
template is not related to the shared template and is not updated with the
original. In the tree view, personal template and folder icons have a folded
upper right corner.
Shared Templates
Only members of the Clinical Coordinator
Authorization/Subscription Utility (ASU) class can create shared templates.
Shared templates are available to all users. Clinical Coordinators can copy and
paste text into a template, type in new content, add Template Fields, or copy a
personal template and then modify it as needed. In the tree view, shared
template and folder icons do not have a folded corner.
Note: When you
install CPRS, a copy of all your existing boilerplate titles is placed in the
inactive boilerplates folder under shared templates.
Clinical Coordinators can arrange the
boilerplate titles that have been copied into the shared templates, use them to
create new shared templates, or make them available to users by moving them out
of the inactive boilerplates folder. Users will not see the inactive
boilerplates folder or its templates unless you choose to make the folder
active.
To activate the
boilerplates folder, Clinical Coordinators should follow these steps:
- Open the Templates Editor.
- Verify that Edit Shared Templates is checked.
- Uncheck Hide Inactive (under shared templates).
- Click the plus sign beside the shared
icon.
Shared Templates includes a lock property that prevents
users from making personal changes when it has been set. The status of the lock
property is displayed in a check box on the Template Editor dialog. When the
Shared Templates root template is locked, no shared templates can be
modified.
For more information on boilerplates, refer to the Text Integration Utility User Manual.
Another area of shared templates is creating Patient Data
Object templates for newly created TIU objects that will enable users to place
these objects into their other templates.
To create a new
Patient Data Object template, use the following steps:
- Open the Template Editor by selecting from the Notes, Consults, or
DC/Summ tab by selecting Options | Edit Shared Templates….
- Verify that Edit Shared Templates is checked.
- Expand the tree view of Shared Templates and then Patient Data
Objects by clicking on the plus sign beside each.
- Click on the existing object above which you want your new object
to be.
- Click New Template and edit the name of the template.
- Place the cursor in the Template Boilerplate box and select Edit |
Insert Patient Data Object or right-click and select Insert Patient Data
Object to bring up a dialog containing a list of TUI objects.
- Click the appropriate TIU object (that was probably just created).
- Click Apply or OK to make the new object
available in GUI templates.
Mark a Template as Default
A default template will automatically be selected the first
time you open the
Templates Drawer. The default template can also be accessed
at any time with the Go to Default Template option. Each tab (Notes, Consults,
and D/C Summ) can have its own default templates.
To set a template as your default template, follow these
steps:
- Open the Template Drawer on the Notes tab
by clicking on it.
The available templates will be displayed
in a tree view.
- Right-click on any template and select Mark
as Default from the right-click menu.
You can set a template as your
default template with a right click menu option
Hide Child Templates
To make child templates unavailable from the template
drawer, follow these steps:
- Start the Template Editor by selecting Options | Edit Templates
from the Notes tab.
- Click Hide Dialog Items from the Dialog Properties option group.
- Click OK.
Display Only
Click this check box to make individual parts of a dialog as
display only. When a template is display only, the check box is removed and the
item is used for information or instructions.
Only Show First Line
Click on this check box and the template will display only
the first line of text followed by an ellipsis (...). The ellipsis indicates
that more text exists. Hold the cursor over the line of text and a Hint box
displays the complete text. This feature gives you the ability to have long
paragraphs of text that do not take up a lot of room on the template. If
selected, the entire paragraph is be inserted into the note.
Indent Dialog Items
Clicking on this check box affects the way that children
items are displayed on the template. When selected, this feature gives the
ability to show hierarchical structure in the dialog. All of the subordinate
items for the selected item are indented.
One Item Only
Clicking on this check box affects the way that children
items are displayed on the template. Click on this check box if you want to
allow only one of the subordinate items to be selectable. Clicking on this
check box changes the check boxes into radio buttons so that only one item can
be selected at a time. To deselect all items, click on the one that is selected
and the radio button will be cleared.
Hide Dialog Items
Clicking on this check box affects the way that children
items are displayed on the template. Click on this option to have subordinate
items appear only if the parent item is selected. This feature allows for
custom user input. The user only sees the options related to the items
selected. This feature requires boiler plated text at the parent level.
Allow Long Lines
A check box in the Template Editor named “Allow Long Lines”
allows template lines to be up to 240 characters in length. This feature mainly
accommodates template field markup.
Types of Templates
When you create templates, you can go directly into the
Template Editor. There, you can type in text, and add Template Fields. If you
are in a document and type in something you will use repeatedly, you simply
select that text, right-click, select Create New Template, and the editor comes
up with the selected text in the editing area. You can create individual
templates, group templates, dialog templates, folders, or link templates to
Reminder dialogs. Template dialogs are resizable.
Templates
Templates contain text, TIU objects, and Template Fields
that you can place in a document.
Group Templates
Group templates contain text and TIU objects and can also
contain other templates. If you place a group template in a document, all text
and objects in the group template and all the templates it contains (unless
they are excluded from the group template) will be placed in the document. You
can also expand the view of the group template and place the individual
templates it contains in a document one at a time.
Dialog Templates
Dialog templates are like group templates in that they
contain other templates. You can place a number of other templates under a
dialog template. Then, when you drag the dialog template into your document, a
dialog appears that has a checkbox for each template under the Dialog template.
The person writing the document can check the items they want and click OK to
place them in the note.
Folders
Folders are used to group and organize templates and assist
in navigating the template tree view. For example, you could create a folder
called "radiology" for all of the templates relating to radiology.
Reminder Dialog
Reminder dialogs can be linked to templates. This allows you
to place orders and enter PCE information, Vitals information, and mental
health data from a template. (Refer to Creating Reminder Dialogs for this
procedure.)
Arranging Templates for Ease of Use
You can use file cabinets and folders to group similar
templates together to make them easier to find and use. For example, you may want to place all of the
pulmonary templates together rather than listing the templates in alphabetical
order.
Adding a Template to a Note
To add a template to a Note, use the following steps:
- From the Notes tab, create a new note by clicking on New Note.
- Complete the Progress Note Properties dialog.
- Click OK.
The Progress Note Properties dialog
will close and the Templates Drawer will appear above the Reminder Drawer.
The Templates Drawer
- Click the Templates drawer
The available templates will
appear.
- Select the template that you would like to use (click the + to
expand a heading)
- Drag the template into the detail area of
the note
-or- double click
on the template
-or-
right click on the
template and select Insert Template.
Note: If the provider has an
NPI, it will not display on the screen below.
Drag the template into the detail
area of the note
Searching for Templates
Searches for templates used to take some time, but changes
included with CPRS v.27 should improve the template search speed.
To search for a template, use the following steps:
- Right-click in the tree view (in either the Template Editor or the
Templates drawer).
- Select the appropriate option: Find
Templates, Find Personal Templates, or Find Shared Templates (depending on
which tree view you are in).
A search field will appear.
Note: You may want to narrow your search by using the Find Options
feature.
- Enter the word or words you want to find and check the appropriate
boxes.
- Select Find.
Note: If the search lasts
longer a few seconds, a dialog displays letting the user know that CPRS is
still looking for the template. This dialog has an animation of a flashlight
and there is a Cancel button is the user wishes to cancel the search.
- If you do not find the template you want, scan the list or select
Find Next.
- Repeat step 5 until you find the desired
template.
Previewing a Template
To preview a template before inserting it into your
document, follow these steps:
- Right-click the template in the Templates drawer on the Notes tab.
- Select Preview/Print Template.
The preview dialog will appear.
Note: You can print a copy of the template by pressing the Print
button.
Deleting Document Templates
To delete a document template, follow these steps:
- Click the Notes, Consults, or D/C Summ tab.
- Select Options | Edit Templates
-or-
if the Templates
drawer is open, right-click in the drawer and select Edit Templates.
- Find the template you want to delete. (Click the + sign to expand a
heading.)
- Right-click the template you want to delete and select Delete. -or- select the template you want to
delete and then click the Delete button under the tree view.
- Click Yes to confirm the deletion.
Creating Personal Document Templates
To speed document creation, you can create personal
templates consisting of text, Template Fields, and Patient Data Objects. You
can use the templates to create progress notes, complete consults, and write
discharge summaries.
Personal Template
To create a personal document template, follow these steps:
- Click the Notes, Consults, or D/C Summ tab.
- Start the Template Editor by selecting
Options | Create New Template
-or-
Select the text that you would like
to save as a template, right-click the text, and select Copy into New Template.
- Type in a name for the new template in the
Name field under Personal Template Properties.
Note: Template names must begin with a letter or a number, be
between 3 and 30 characters in length (including spaces), and cannot be named
"New Template."
- Click the drop-down button in the Template Type field and select
Template.
- Enter the content for the template by
copying and pasting from documents outside CPRS, typing in text, and/or
inserting Template Fields.
Note: After you enter the content, you can right-click in the
Template Boilerplate area to select spell check, grammar check, or check for
errors (which looks for invalid Template Fields).
- Place the template in the tree view in the desired location. (To do
this, click the plus sign next to an item to view its subordinate objects
and then drag and-drop the template to its desired location. You can also
move the template by using the arrows below the personal templates tree
view.)
- Click Apply to save the template.
- Click OK to save and exit the editor.
Note: You are not required to click Apply after each template, but
it is recommended. If you click Cancel, you will lose all changes you have made
since the last time you clicked Apply or OK.
Group Template
You can create group templates which contain other
templates. You can then place the entire group template in the note, which
brings in the text and Template Fields from all templates in that group, or
expands the tree view in the Templates drawer and places the individual
templates under the group template in the note.
To create a personal Group Template, follow these steps:
- Click the Notes, Consults, or D/C Summ tab
- Select Options | Create New Template
-or-
Select the text that you would like
to save as a template, right-click the text, and select Copy into New Template.
- Enter a name for the new template in the
Name field under Personal Template Properties.
Note: Template names must begin with a letter or a number, be
between 3 and 30 characters in length (including spaces), and cannot be named
"New Template."
- Click the drop-down button in the Template Type field and select
Group Template.
- Enter the text and Template Fields to
create content in the main text area of the group template, if desired.
(You can enter content by copying and pasting from documents outside CPRS,
typing in text, and/or inserting Template Fields.)
Note: After you enter the content, you can
right-click in the Template Boilerplate area to select spell check, grammar
check, or Check Boilerplate for Errors, which looks for invalid Template
Fields.
Note: You can also create additional templates under
the Group Template that you just created. To do this, simply highlight the
appropriate group template and click New Template. Then complete the steps for
creating a new template outlined above.
- Place the template in the tree view in the desired location. (To do
this, click the plus sign next to an item to view its subordinate objects
and then drag and-drop the template to its desired location. You can also
move the template by using the arrows below the personal templates tree
view.)
- Click Apply to save the template.
- Click OK to exit the template editor.
Note: You
are not required to click Apply after each template, but it is recommended. If
you click Cancel, you will lose all changes you have made since the last time
you clicked Apply or OK.
Associating a Template with a Document Title,
Consult, or Procedure
Clinical Coordinators and others who are authorized to edit
shared templates and who are also members of the appropriate user class
(specified in the EDITOR CLASS field, #.07 of the TIU TEMPLATE file #8927) may
see the Document Titles, Consult Reasons for Request, and/or the Procedure
Reasons for Request template folders. These folders allow you to associate a
template with a progress note title, a procedure, or a type of consult. After
an association is created, the appropriate template content is inserted in
either the body of a note (when a new note is started) or in the Reason for
Request field (when a new consult or procedure is ordered).
To associate a template with a document title, type of
consult, or a procedure, follow these steps:
- Create a new template (by following the
instructions above for either the personal template or the group
template)
-or-
edit an existing
template by selecting Options | Edit Templates….from the Notes,
Consults, or D/C Summ tab.
- Click the Edit Shared Templates check box located in the lower left
hand corner of the Template Editor window.
- Select the template you would like to associate from the Personal
Templates section of the Template Editor window.
- Drag and drop the template into either the Document Titles, Consult
Reasons for Request, or Procedure Reasons for Request folder in the Shared
Templates area of the window.
- Select the template that you just moved (click “+” to expand a
heading) in the Shared Templates area of the window.
- Select a procedure from the Associated
Procedure drop-down list
-or-
select a consult
service from the Associated Consult Service drop-down list.
- Click OK.
The template is now associated.
When you order a consult or a procedure, the associated
template text will appear in the Reason for Request field. When you enter a new
progress note the associated template text will appear in the text of the note.
Importing a Document Template
You can import existing template files (.txml), Microsoft
Word files (Word 97 or higher), or XML files into the CPRS Template Editor.
To import a template, follow these steps:
- Start the Template Editor.
- Browse to the file cabinet or folder where
you would like to store the imported template (click “+” to expand a
heading).
Note: To import a template to the Shared Templates area of the
screen, you must be authorized to edit shared temples and place a checkmark in the Edit Shared Templates check box
(located in the lower left side of the Template Editor).
- Select Tools | Import Template.
- Select the file you would like to import and click
Open.
- The template will appear in the Template Editor.
- If you press OK, the template will be
imported without the new fields. If you press Cancel, the import process
will be cancelled.
Note: If you do not have authorization to edit template fields, you
may see this dialog.
The template field warning dialog
Exporting a Document Template
You can also export a template or a group of templates with
the Template Editor. Exported templates are saved with the .txml file
extension.
Note: Patient data objects are not exported with a template.
To export a template or a group of templates, follow these
steps:
- Start the Template Editor.
- Select the template or group of templates (file cabinet) that you
would like to export.
- Select Tools | Export Template.
- Choose a destination and file name for the template file.
- Click Save.
Dialog Template
Dialog templates contain other templates. If there is more
than one template, each template under a dialog template will have a check box
next to it when the template is placed in a document. A single template under a
dialog template will not have a check box. Pressing the OK button inserts the
dialog element into the note.
If you double-click a dialog template or drag it onto the
note, a dialog appears. The dialog shows the text for each template preceded by
a check box.
Click the box to check which items are to be included in the
note. You can click All to select all of the elements or None to start over.
Click OK when you have completed your selection.
A
dialog template
To create a personal Dialog Template, follow these steps:
- Select Options | Create New Template on the
Notes, Consults, or D/C Summ tab to bring up the Template Editor
-or-
Select the text that you would like
to save as a template, right-click the text, and select Copy into New Template.
- Enter a name for the new template in the
Name field under Personal Template Properties.
Note: Template names must begin with a letter or a number, be
between 3 and 30 characters in length (including spaces), and cannot be named
"New Template."
- Click the drop-down button in the Template Type field and select
Dialog.
- Enter the text and Template Fields to
create content in the main text area of the template, if desired. You can
enter content by copying and pasting from documents outside CPRS, typing
in text, and/or inserting Template Fields.
Note: After you enter the content, you can
right-click in the Template Boilerplate area to select spell check, grammar
check, or Check Boilerplate for Errors, which looks for invalid Template
Fields.
Note: You can also create additional templates under
the Group Template that you just created. To do this, simply highlight the
appropriate group template and click New Template. Then complete the steps for
creating a new template outlined above.
- Place the template in the tree view in the desired
location. (To do this, click the plus sign next to an item to view its
subordinate objects and then drag and-drop the template to its desired
location. You can also move the template by using the arrows below the
personal templates tree view.)
- Click Apply to save the template.
- Click OK to exit the template editor.
Note: You are not required to click Apply after each
template, but it is recommended. If you click Cancel, you will lose all changes
you have made since the last time you clicked Apply or OK.
Reminder Dialog
Templates can be linked to Reminder dialogs that are listed
in the TIU Reminder Dialogs parameter. This enables you to use templates to
place orders, enter PCE information, and enter vital signs and mental health
data. If there are no Reminder Dialogs in the TIU Reminders Dialog parameter,
the Reminder Dialog template type will not be available.
To create a Reminder Dialog, follow these steps:
- Select Options | Create New Template… on
the Notes, Consults, or D/C Summ tab.
The Template
Editor will appear.
- Type in a name for the new template in the
Name field under Personal Template Properties.
Note: Template names must
begin with a letter or a number, be between 3 and 30 characters in length
(including spaces) and cannot be named "New Template."
- Click the drop-down button in the Template Type field and select
Reminder Dialog.
- Click the drop-down button in the Dialog field and select the
Reminder Dialog desired.
- Place the template in the tree view in the desired location. (To do
this, click the plus sign next to an item to view its subordinate objects
and then drag and-drop the template to its desired location. You can also
move the template by using the arrows below the personal templates tree
view.)
- Click Apply to save the template.
- Click OK to exit the editor.
Note: You do not
have to click Apply after each template, but it is recommended because if you
click Cancel, you will lose all changes you have made since the last time you
clicked Apply or OK.
Folder
Folders are simply containers that allow you to organize and
categorize your templates. For example, you might want to create a folder for
templates about diabetes or one for templates about mental health issues.
To create a personal template folder, complete the following
steps:
- Select Options | Create New Template on the
Notes, Consults, or D/C Summ tab to bring up the Template Editor
-or-
Select the text that you would
like to save as a template, right-click the text, and select Copy into New Template.
- In the Name field under Personal Template Properties, enter a name
for the new folder. For ease of use, you should create a name that
describes the content of the template.
- Click the template type: Folder.
- Drag-and-drop relevant templates into the
template folder that you have created.
Note:
It is recommended that you click Apply after adding a template to save your
changes. If you accidentally click Cancel, you will lose all the changes you
have made since the last time you clicked Apply or OK.
View Template Notes
Template Notes can be used to describe what is in the
template or to track changes to the template.
To add or display Template Notes, follow these steps:
- Click the Notes tab.
- Click Options | Edit
Templates.
- Select the shared or personal template for which you wish to add or
change the Template Notes.
- Click the Show Template Notes check box at the bottom of the
dialog. The Template Notes field
appears below the Template
Boilerplate field.
- Add or change the note as much as you wish.
Note: If the template you wish to edit is a shared template and you
have the authority to edit it, you will need to click the Edit Shared Templates
check box on the lower left corner of the Template Editor dialog.
To add or display Template Notes from the Template Drawer,
complete the following steps:
- Select Options
| Edit Templates… from the
Notes, Orders, or D/C Summ tab.
The Template Editor will
appear.
- Select the shared or personal template for which you wish to add or
change the Template Notes.
- Click the Show Template Notes check box at the bottom of the
dialog. The Template Notes field
appears below the Template
Boilerplate field.
- Add or change the note as much as you wish.
Note: If the template you wish to edit is a shared template and you
have the authority to edit it, you will need to click the Edit Shared Templates
check box on the lower left corner of the Template Editor dialog.
Copying Template Text
To copy text from a template to any text field, complete the
following steps:
- Open a new note, consult or discharge summary.
- Select a note, consult or discharge summary title.
- Click the Notes tab
- Click the Templates drawer button.
- Expand either the Shared Template or Personal Templates tree.
- Right-click the desired template.
- Click Copy
Template Text (or press Control+C) to copy the text to the clipboard.
Note: You can paste the
copied text into any text field by right clicking in the desired field and
selecting Paste.
Template Fields
Template fields allow you to create text edit boxes and
lists of text that can be selected via combo boxes, buttons, check boxes, or
radio buttons. Through a new type of markup syntax {FLD: TemplateFieldName},
these controls can be added to templates, boilerplate titles, boiler plate
reasons for request, and reminder dialogs. A Template field editor has also
been added that can be used by members of the ASU user classes listed in the
new TIU FIELD EDITOR CLASSES parameter.
You can access the template field
editor through the options menu on Notes,
Consults and D/C Summaries tabs, as well as through the new
Template Editor
Tools menu. There is also a new Insert Template Field menu
option in the Template Editor, following the Insert Patient Data Object menu
option. You can enter free text into Template Field Combo boxes.
Template Dialogs will now show an asterisk (*) before
required template fields (as well as highlight them if enabled), and will not
allow you to press the OK button if you have not completed the required fields.
A message has also been added at the bottom of the template dialogs that states
“* Indicates a Required Field.”
Template Fields can also be used in boilerplate text that
can be associated to a new Note, Consult, or Discharge Summary.
The
Template Field Editor
When you click the Preview button, you can view how the
template dialog will appear. Since the Separate Lines check box is enabled on
the Template field Editor dialog, the check box items on the preview are listed
on a separate line. You can mark these fields as required if desired. Template
Field Preview forms are resizable.
You
can use the Preview button to preview a template dialog
Using the Template Field Editor
You can reduce the time required to complete a note,
consult, or discharge summary by adding template fields to your templates and
dialogs. Information that you would normally have to look up can be pulled
directly into your note, consult, or discharge summary from the template fields
in your templates.
To view the predefined characteristics of the template
fields:
1.
Select the Notes, Consults, or D/C Summ
tab.
2.
Select Options | Edit
Template Fields.
3.
Select the desired
template field in the Template Fields list on the left side of the dialog. The
field is copied to the Name field on the right side of the dialog and all of
the existing elements of the field are displayed.
4.
Click Preview to see
how the Template Field will appear on a template or click OK to complete the procedure.
To create a new template field:
1.
Select the Notes,
Consults, or D/C Summ tab.
2.
Select Options | Edit
Template Fields.
3.
Select New.
4.
Type a unique name for
the new template field.
5.
Select a Type:
● Edit Box
● Combo Box
● Button
● Check boxes
● Radio buttons
● Date
● Number
● Hyperlink
● Text
● Word Processing
6.
Fill in the necessary
fields, such as the type of date, any default value that should appear, or
minimum and maximum numbers.
7.
Add the necessary text
or items.
8.
Select Preview to see
how the item will look, and then close the Preview box.
9.
If it is satisfactory,
select Apply to save and stay in the Template Field Editor or select OK to save
and exit the editor.
If Edit Box is selected, type or select a number between 1
and 70 into the Maximum Number of Characters field. If Combo Box, Button, Check
Boxes or Radio Buttons are selected as the Type, the Default field and Maximum
Number of Characters fields are unavailable. The Items field and the Default
field below Items are active.
The Default field below the Type field is available only
when Edit Box is the Type selected. Type the text that you wish to have appears
in the Edit Box by default. On the template, the user can accept the default
text or change it, as long as the new text is within the Maximum Number of
Characters limit.
If the Type is Combo Box, Button, Check Boxes, or Radio
Buttons, the Items field will be active. Type the different choices from which
you wish to let the user choose. Each item must be on a separate line in the
Items field. However, if you wish to have the Items listed on separate lines in
the template, you must enable the Separate Lines check box.
If the Type is Combo Box, Button, Check Boxes, or Radio
Buttons, the second Default field will be active. If you wish, you may click
the drop-down button and select one of the items as the default.
If you wish, you may type text in the LM Text field and it
will appear in the List Manager version. Template Fields have been developed
strictly for GUI functionality. If you are still using LM, the text {FLD:
TEMPLATE FIELD NAME} will appear in LM body of the note. To avoid this, type
text in this field.
If the field being created on the template is required,
enable the Required check box, which will prevent the template from being
closed without the field being selected or completed.
You may include text in the Notes field that will explain or
describe the Template Field. You may also use it to record changes that have
been made to the Template field. The text typed into this field will not appear
on the template. These notes will not appear to a user when entering a note.
They are for development use only as notes to the creator.
Click Preview to see how the Template Field will appear on a
template or click OK to complete the procedure.
Inserting Template Fields into a Template
Once you have decided which Template fields to use or you
have defined the Template Field that you need, you can add them into a
template. With the Template field in the Template, you can quickly and easily
select the items you wish to add to a note, consult or discharge summary.
Developers added two new template fields to CPRS v.27 to
enable sites to better serve their visually impaired users:
● Screen Reader Stop Code
● Screen Reader Continue Code
Screen readers work by speaking text
and labels on dialogs and forms presented to the user. The screen reader will
stop when it gets to a control, such a drop-down box or some other item. These
codes will allow the users who create templates at the sites to control when
the screen reader needs to stop and when it would be better for it to continue.
For example, if in the template, the user needs to enter a number, but some
explanatory text after the number is needed, the Screen reader Continue Code
will enable the template creator to make the screen reader continue reading to
give the visually impaired user all the information he or she needs. Another
example would be some text that normally would not be read until a button
received focus.
These codes enable template creators to more tightly control
what is read when the screen reader is running. When it is not, they will not
have the effect. Template creators will need to work with visually impaired
users to ensure the templates are reading correctly.
To add a Template Field into a Template:
- From the Notes, Consults or D/C Summ tab, click Options | Edit
Templates... or Create Templates, Edit Shared Templates, or Create New
Shared Template...
- From the Template Editor, select the template to which you wish to
add a Template Field.
- Insert the cursor at the place in the Template Boilerplate field
where you wish to insert the Template Field.
- From the toolbar, click Edit | Insert Template Field or right-click
in the template and select Insert Template Field.
- On the Insert Template Field dialog, type the first few letters of
the desired field or scroll through the list until the desired field is
located.
- Click the field you wish to insert.
- Click Insert Field.
- Repeat steps 5 through 7 for each additional Template Field you
wish to insert.
- Click Done when you have added all of the desired template fields.
- From the tool bar, click Edit | Preview/Print Template or
right-click in the template and select Preview/Print Template. This will
preview the template. If the template does not display with the desired
appearance, you may continue to edit it.
- On the Template Editor dialog, click OK to
save the changes to the template.
Note: The Insert Template Field dialog is non-modal and can be used
as a boilerplate if desired.
Navigating Template Required
Fields
To aid in the completion of
template dialogs, a navigation bar is available to assist with finding and
completing “required” fields. This
navigation bar will allow the user to quickly access all required fields in the
template dialog. The navigation bar
provides a count of all unanswered required fields and provides navigation
buttons to allow the user to jump directly to the required field. In addition to the * used to identify
required fields, all incomplete required fields will be highlighted within the
template. Once the required field is
filled in, the counter will reduce and the highlight for the field will be
removed.
Note: Sites can decide to turn off these additional
features for required fields. If you do not see these features, it could be
that the features, they could be disabled.
This progress note template shows
required fields with asterisks and yellow highlighting. On this dialog, there
is a Required Fields without Values field and a navigation bar.
Required Fields Settings
Users can set preferences for the
navigation bar location (Top, Left, Right, and Bottom) and whether the new
highlight feature displays and the highlight color.
Navigation Bar Location: The user can set the navigation bar
position in three ways:
● a context menu (right-click menu) on the navigation bar
itself, then select the location
Right-click on the Navigation bar to
select where it displays.
●
a context menu (right
click menu on the main dialog, then select Set Highlighting Preferences, then
select the location on the dialog that displays (This method and the following
one bring up the same dialog.)
Users can select Required Fields
preferences.
● Going to Tools |Options | Notes tab, then select the
Required Fields button, and then selecting the location.
Enable/Disable Highlight and Setting the Highlight Color: The user
can enable or disable the highlight and navigation bar features in two ways:
● The user also can enable/disable the highlighting within
the template by accessing the Right Click (Context) menu associated with the
body of the template, the user will see an option to Highlight Required Fields.
When checked highlighting is enabled, while when it is unchecked the
highlighting is disabled. The user can
also select the highlight color.
● Another way to bring up the dialog is to select Tools
|Options | Notes tab and then select the Required Fields button
Here, you
will be able to enable/disable highlighting, change the highlight color, and
change the Navigation Bar position.
Auditing Copying
and Pasting into Clinical Documents
To improve clinical documentation, CPRS now enables individuals designated by
medical centers to review clinical documents to audit how much text within the
documents has been copied and pasted from another location.
Note: This feature is
new with CPRS GUI v31b and patch TIU*1.0*290. Only documents created after the
installation of these patches will have copied and pasted text tracked.
Excessive copying and pasting
has at least these impacts on healthcare:
● unnecessary duplication of information
● lengthening of notes and making chart reading more
difficult
● slowing the retrieval of notes by the workstation
● improving accuracy of the note and the patient information
To help sites better audit
what text is copied and pasted into clinical documents, CPRS defines
● who can view pasted text
● what constitutes tracked pasted text
● how CPRS will display pasted text
● how the person auditing can turn on or off the display of
pasted text
● how the auditor can view the pasted text
Who Can View Pasted Text?
In CPRS, pasted text can be
viewed by the document author and cosigner before signature. When the note is
signed, the displayed text becomes a part of the note and is no longer visible
to the author or cosigner unless they belong to one of the user classes that
the site has designated to be able to view pasted text.
After signature, only
individuals assigned to specific User Classes will be able to view text that
has been copied and pasted. With CPRS v31b, three User Classes are assigned to
be able to audit copying and pasting by defaults:
●
CHIEF, MIS
●
CHIEF, HIMS
●
PRIVACY ACT OFFICER
In addition, sites can give
other user classes the ability to view copy/paste data.
What Constitutes a Tracked Paste?
If a
user pastes text into a clinical document within CPRS, CPRS will track that as
a paste if it meets several criteria. When a user copies information within
CPRS, CPRS will store characteristics about the copied text if it is available,
such as the title and author of the document it came from, or whatever
information it can about the source. The information gathered when text is
copied can then be displayed if the text is pasted.
If text is copied from outside
of CPRS or it is altered after being pasted into CPRS, the source information
may simply read “Outside of current CPRS tracking,” meaning that CPRS does not
know where it came from.
Character Limits for Pasted Text
A 20,000-character limit is
hard-coded for tracking the source of a paste. If a paste exceeds 20,000
characters, CPRS will not try to track the source. It will still show on the
report and the percentage will be calculated as discussed below. So, the text
is tracked, but the source is not determined.
Other Copy/Paste Characteristics
that Sites Can Set
There are several criteria
that determine whether a copy and paste will be tracked or displayed with
identifying marks in CPRS. Sites have some control over how these criteria are
set. The criteria are as follows:
● Minimum Number of
Words: To be considered a paste, there
must be at least the specified number of words. For example, if it is set at 15
words and a user pastes 14, CPRS will not identify it as a paste. The default
is 5 words.
● Percentage Check: Because providers often edit text after it is pasted, CPRS
checks what percentage of the original paste is in the document. For example,
if this percentage is set at 85 percent and the user pastes some text but then
edits it so that only 75 percent of the original text remains, it will not
display as pasted text. The default is 90% unless changed by your site.
● Role: Until, the author and cosigner can see highlighted pasted
text. After the note is signed, only users in specific user classes will see
the pasted text.
● Exclude Note
Title: Site can specify notes that will
not be tracked for copy/paste.
● Exclude
Application: Sites can specify that
specified applications are not tracked for copy/paste. One application
(netspeak.exe) is already included in this parameter.
Clinical Application
Coordinators (CACs) set the values for these parameters.
When Text Will Not Display as Pasted
In addition to these
parameters, certain actions will determine whether pasted text displays in CPRS
with its identifiers.
● After Signature: While the author of a note is writing the note or editing
it, CPRS will identify pasted text with highlighting or other methods as set by
the user, if it meets the criteria above. If the author or cosigner of the
document signs the document and they are not in the designated user class that
can view pasted text, the pasted text will no longer be identified for them as
pasted. In other words, if it is highlighted, it will no longer be highlighted
and the area showing the pastes will not display it. The pastes can still be
identified to auditors in CPRS.
●
Within the Same Note:
When text is copied and pasted from within the same note.
●
Lines with 2 words or less: Lines with 2 words or less are not highlighted, but they
are tracked.
Setting How Pasted Text Will Display
to Auditors, Authors, and Cosigners
CPRS has several options to
determine how pasted text will display to reviewers, those who are in user
classes that can view copied and pasted text. The user can select one method or
combine all of them:
● Bold
● Italics
● Underline
● Highlight
Auditing users can select to
make text bold and italicized or whatever combination or individual text
attribute they would like to show that a user pasted it. The user’s selection
is stored in a CPRS parameter, but it is set in the CPRS GUI.
Auditing users can also turn
on or off the identifying of copy/paste text in the detailed display so that
users can see what was originally pasted with text that was changed
highlighted, or the feature can be turned off. The edited text is in the body
of the note, while the original text is marked in the detailed display.
To set what characteristics will indicate text that has
been pasted into a clinical document, use these steps:
1.
In CPRS, bring up the Options
dialog by selecting Tools | Options.
2.
Select the Copy/Paste tab.
3.
Under the “How text is
identified on the note” section, select which attributes or combination of
attributes you want to identify pasted text by checking the box for each
attribute:
Bold
Italics
Underline
Highlight
From the Tools | Options dialog on the Copy/Paste tab, the
auditing user can choose any combination of the way CPRS should display the
options.
4.
If you select Highlight, you
may also use the default color or choose a different color. To select a
different color, select the drop-down arrow and choose the color:
Black
Maroon
Green
Olive
Navy
Purple
Gray
Silver
Red
Lime
Yellow
Blue
Fuchsia
Aqua
White
5.
If you would like to see in
the detailed display the original text that was replaced, check the Display
differences between what was paste in details pane check box.
6.
When done, select OK.
Auditing Pasted Text in Clinical
Documents
When a user is in the
appropriate user class, the user can view pasted text in signed notes according
to the parameters the site has set for what constitutes pasted text. For
authorized users, the notes will display with a Pasted Data pane. In this pane are
two areas: a listing of all items that were pasted into the note. The items are
identified as New before the note is saved or signed and by the date after it
is saved or signed.
When the user selects an item
by the date, the text of the paste displays in a pane next to the list of
pastes. Also, the text displays as a pasted in the way the user selected (bold,
highlighted, underlined, italicized, or a combination of these attributes).
This screen
capture shows a progress note on the Notes tab. The person viewing the note is
in a class that enables them to see pasted text. The Pasted Data pane enables
the user to select items that have been pasted so that they can be reviewed.
To view pasted text in CPRS, use these steps:
1.
On the Notes tab, if you have
been assigned as a user who can audit and there is text that has been pasted
into the note you are viewing, you will see a new Pasted Data pane below the
main note pane.
2.
To view what text has been
pasted, select an item from the list under Pasted Data by clicking it or
tabbing to it.
3. When an item is highlighted, such as when the user selects
a date, the pasted text will display in the pane to the right of the list and
it will be displayed as the user defined on the Notes tab of the Options
dialog. In the pane to the right of the Pasted Data List, the user can see the
following information about the pasted text:
Date: The date the paste was made
User: Which user pasted the data
From: The Source (if VistA the source will be known, if from
outside VistA, it may just read from outside)
Copied from
Patient: This will tell what patient the
data was copied from if known.
Percentage: What percentage of the original text was pasted.
Pasted Text: This displays the text that was pasted. This is especially
useful for user who might have visual difficulties.
4.
To view other pasted entries,
simply select the appropriate item (or date) in the list.
Consults are requests from one clinician to a hospital,
service or specialty for a procedure or other service.
The Consults process involves the following steps. A single
individual or service does not take all of the steps.
- The clinician orders a consult. From within the patient’s CPRS
medical record, the clinician enters an order for a consultation or
procedure. The ordering clinician may first have to enter Encounter
Information.
- The consult service receives an alert and a printed SF 513. The
receiving service can then accept the consult, forward it to another
service, or send it back to the originating clinician for more
information.
- The consult service accepts or rejects the consult request. To
accept the consult, the service uses the receive action. The service can
also discontinue or cancel the consult. Cancelled consults can be edited
and resubmitted by the ordering clinician. A consult service clinician
sees the patient.
- The consult service enters results and comments. Resulting is
primarily handled through TIU.
- The originating clinician receives a CONSULT/REQUEST UPDATED alert
that the consult is complete. The results can now be examined and further
action taken on behalf of the patient.
- The SF 513 report becomes part of the patient’s medical record. A
hard copy can be filed and the electronic copy is on line for paperless
access.
- Results from the Medicine package can be attached to complete
consults involving procedures. This function is available through the GUI
for the Consults package, but will only be seen when the supporting
Consults patch GMRC*3.0*15 is installed. The absence of these patches will
result only in the function not being present.
- If Consults patch GMRC*3.0*18 has been installed, the Edit/Resubmit
action is available for cancelled consults. The consult must be
“resubmittable” and the user must be authorized to resubmit consults.
- The Consults tab has a list of consults in a tree view similar to
the ones found on the Notes tab and the Discharge Summary tab. However,
the list view feature is not available due to differences in the tabs
functions. Consults are differentiated from procedures in the tree by the
type of icon displayed. Consults are represented by a notepad, while
procedures are represented by a caduceus-like symbol.
- Right-click in the Consults text and you may select the “Find in
Selected Consult” option from the popup menu. This option allows you to
search the displayed text. A “Replace Text” option is also available, but
it is only active when a consult is being edited.
- The field below the
list of consults displays a list of documents related to the highlighted
consult or procedure. These related documents are also in a tree view.
Note: If the provider has an NPI, it will not display on the screen
below
The Consults tab
Changing the View on the Consults tab
Changing the view of the Consults tab allows you to focus
the list of consults on one of several criteria. Focusing the list will speed
up the selection process. You may change the Consults view to only include the
following problems:
● All Consults
● Consults by Status
● Consults by Service
● Consults by Date Range
To change the view, click View on the menu and select the
desired list items.
You may select the Custom list option
on the menu to further focus the list of notes you wish to have displayed. From
the List Selected Consults dialog, you may choose to display consults by any
combination of service, status, and date range. You can also group your results
by consults versus procedures, by service, or by status.
From
the List Selected Consults dialog, you may choose to display consults by any
combination of service, status, and date range
The Consults tab on the Icon Legends dialog includes a
description and explanation of the different icons that appear on the Consults
tree view. To access the Icon Legend, click View | Icon Legend and the click
the Consults tab.
The
Consults tab on the Icon Legends dialog includes a description and explanation
of the different icons that appear on the consults tree view
Ordering Consults
You can order a consult or procedure from either the
Consults or the Orders tab. As you fill in the options, the consult request
will be displayed in the text box at the bottom center of the dialog.
The list of Consults has been changed to a tree view.
Consults are distinguished from procedures in the tree by the icon displayed in
the tree. Consults are represented by a notepad, while procedures are
represented by a caduceus-like symbol.
Note: If the
provider has an NPI, it will not display on the screen below.
Consults
and procedures are listed on the Consults tab
Viewing Consults
To view the consults or procedures for the selected patient,
use the steps below. When you select a specific consult, you will see an area
that lists any notes associated with the consult. You can also click a note
entry to view the full text of the note.
The All Consults list box shows the date, status (p=pending,
c=complete, dc=discontinued, and x=cancelled), and title of each consult. An
asterisk preceding the title tells you that there are significant findings for
that consult.
To view consults, follow these steps:
- Select the Consults tab.
- Select the consult you would like to view
from the All Consults list.
The text of the consult will appear
in the details pane. Any notes associated with that consult or procedure will
appear in the Related Documents pane. To view the text of a related note, click
on the note.
Note: The All Consults list shows the
date, status (p=pending, c=complete, dc=discontinued, and x=cancelled), and
title of each consult. An asterisk preceding the title tells you that there are
significant findings for that consult.
If a note listed in the related documents pane is a CP-class document,
the Date/Time Performed and Procedure Summary Code fields will
appear in the full text of the document.
Below is an example of a detailed
display of a Consult
This screen capture shows a detailed
view of a consult
Note: If the
provider has an NPI, it will not display on the screen above
Tracking Consult Requests
When CPRS displays a request for a new consult, the user can
take several actions from the Consult Tracking menu item:
•
Receive* – When the
request arrives at the specified service, the designated person, such as a
clerk, can use Receive to change the consult status to active.
•
Schedule – The service
can schedule a consult, which makes the consult available to be resulted.
•
Cancel (Deny) – A
consult service may cancel or deny a consult request because of incomplete
information or for some other reason. The consult requester is then notified
that the consult was canceled so that the requester can take appropriate
action.
•
Discontinue* – The
user can discontinue a consult if it is no longer needed.
•
Forward* – The user
can forward a consult if the user is not the appropriate person for the
consult.
•
Add Comment* – The
user can add comments and designate to whom the comment should go in an alert.
•
Significant Findings* – The
user can add significant findings and designate them as such.
•
Administratively Complete* – Allows
completion of a consult without creation of a new progress note.
* These actions are supported by the Consult
Toolbox, which automates and assists the user’s ability to enter common
actions. Right click in the comment area and select the desired type of action.
Using the Consult Toolbox Functions
The Consult Toolbox provides user functionality in the
“Receive Consult,” “Add Comment to Consult,” and “Discontinue Consult” dialogs
in CPRS. To activate any of these functions, choose the item under the Action
menu on the CPRS Consults tab, and the CPRS dialog for that action will open.
If you have enabled automation, the appropriate Consult Toolbox action screen
will then automatically open. If the Consult Toolbox hasn’t been automated, the
box will open normally. To manually open the consult toolbox, right click in
the dialog’s Comment area.
When the Consult Toolbox displays, the user can select from
a number of possible comments listed to document what action the user took. As
the user selects items in the Consults Toolbox, text is entered into the
comment dialog box.
Add Comment example:
Add Comment to Consult example (with right mouse button
clicked):
Note that you can also access the settings screen with a
right mouse click in the comment area of the CPRS box.
Discontinue Consult Examples:
Similar functionality exists for
Consult Forwarding (to community care), Significant Results, and for
Administratively Complete.
For more information regarding how users can configure and
use the Consult Toolbox, please use the link below to find the Consult Toolbox
User Manual:
KMS site (you may need to sign in with PIV): REDACTED
Alerts
Many of the above actions send an alert to the recipients
for the service and/or back to the requester to let them know that the status
of the request has changed or that some has taken some action on the request.
CPRS alert recipients follow these rules:
•
When a user takes an
action on a consult that generates an alert, that individual should not receive
the alert.
•
If an ordering
provider, that is a member of a consult team, takes an action on a consult, the
alert should be sent to the consult team and not to the ordering provider.
•
If an unrestricted
access user, that is not the ordering provider or a member of the consult team,
acts on a consult, the alert should be sent to both the consult team and the
ordering provider.
Complete a Consult or Clinical Procedure the
Consults Tab
Note: Until
Clinical Procedures 1.0 is released, completion of all consults and procedures
will continue to function as it does currently.
After the installation and implementation of Clinical Procedures 1.0,
any procedure defined as a Clinical Procedure will be completed using a
document from the "Clinical Procedures" TIU class, which has some
unique properties. In addition, to
complete a Clinical Procedure, a person must be defined as an interpreter
(update user) for the consult service to which the Clinical Procedure was
directed.
To complete a consult from the
Consults tab, complete the following steps:
1.
Select the Consults
tab.
2.
Select Action |
Consult Results | Complete/Update Results.
Note: If this visit is
undefined, you will be prompted for encounter type and location, clinician,
date, and type of visit, such as Ambulatory, Telephone, or Historical.
3.
In the Consult Note
Properties dialog, select Progress Note Title (e.g., General, SOAP, Warning,
etc.). For titles that require entry of a cosigner, another field will display
where the user can enter the information.
Note: If the provider has
an NPI, it will display on the screen below.
See the "National Provider Identifier (NPI) Display in CPRS section
for an example of an NPI displaying on a screen
In the Consult Note Properties
dialog, the user selects the items for the note that will complete the consult,
including the Note title, the date and time (if not when the user began the
note), and the author, which should default to the user if the user is a
provider
4.
If necessary, change
the note date by selecting the button next to the date and entering a new date
or by typing in a new date and time directly in the field.
5.
If necessary, change
the note author by selecting the author from the Author drop-down list.
6.
Enter any additional
information, such as an associated consult or an expected cosigner. Completing
these steps will allow the note to be automatically saved.
Note: Occasionally a
problem occurs if a cosigner’s access lapses and they have become “disusered.”
If this occurs, you can click OK and proceed with that selection or click
Cancel and choose another cosigner.
7.
Select OK.
8.
Create your note by
typing text, using templates, and including any test results.
Note: If you need to view
the consult details while writing a note, bring up the popup menu by right-clicking
in the note editing pane and choosing View Consult Details or using the
shortcut Shift+Ctrl+U.
9.
From the Action menu,
select either Sign Note Now or Save without Signature.
Note: The Date/Time Performed and Procedure Summary Code fields must also
be completed on the first CP document that completes the procedure request.
Completing the Date/Time Performed
and Procedure Summary Code fields is
optional on subsequent CP documents.
Ordering a New Consult from the Consults Tab
To create a new consult from the Consults tab, complete the
following steps:
- Go to the Consults tab.
- Select the New Consult button.
- If the Provider and Location for Current Activities dialog opens,
fill in the Visit Location and other information, and select OK.
- Select a service from in the Consult to
Service/Specialty window.
When you select the Consult Service
or Specialty, several things may happen:
o
If the service has
some prerequisites, a dialog will display stating what those are and will allow
you to print the information, continue to place the consult order, or cancel
the order.
o
In addition, any
predefined text or template will display to help the user fill out the Reason
for Request field.
o
The Provisional
Diagnosis field becomes active as well.
- Select the urgency from the Urgency field.
- Select the person to whom you are sending
the consult from the Attention field.
Note: To help you
distinguish between providers, CPRS displays their titles (if available). When
two or more providers have identical names, CPRS also displays:
o The service/section and
site division (if any) associated with these providers; site divisions are
displayed based on the following rules:
● When no division is listed for a provider, no division is
displayed.
● If only one division is listed, this division is displayed.
● If the site has multiple divisions or more than one
division is listed and one of these
listed divisions is marked as Default, CPRS displays the division marked as
Default.
● If more than one division is listed for a provider and none
is marked as Default, CPRS does not display division information for this
provider.
o Providers who are listed
in the New Person file as Visitors are screened out from the provider list.
(These screened-out providers are listed as Visitors because their entries were
created as a result of a Remote Data View.)
- If necessary, enter a different Clinically
Indicated Date.
Note: The Clinically Indicated Date field does not apply to
Prosthetics consults services, and the field is not available when the user
selects a Prosthetic service.
- Select whether the consult is for an inpatient or an outpatient.
- Select the Place of Consultation from the list.
- Enter a Provisional Diagnosis
For each consult, this field is
either set up to require that
o
The user type in an
answer (the box will be white and the Lexicon button unavailable), or
o
The user must select a
response from the Lexicon (the field will be yellow and the Lexicon button is
available).
●
CPRS will search for
diagnoses that contain the search term.
The matching terms will display in the bottom portion of the Problem
List Lexicon Search dialog. The search now looks for SNOMED Concepts Terms
(SNOMED CT) items. Most items will also be mapped to an ICD-9-CM code. The list
will show the SNOMED concept text, the SNOMED code, and the ICD-9-CM code if
the term is mapped to one.
● If you do not see the appropriate problem listed, select
the Extend Search button. On the Consults tab, the Extend Search button extends
the search to the ICD-9-CM clinical hierarchy to find additional terms.
Note: If a user tries to
enter a diagnosis with an inactive code, CPRS will bring up a message
indicating that the code must be changed and giving the user the chance to
choose a diagnosis with and active code.
● Beginning on October 1, 2014, CPRS will use ICD-10-CM codes
when providers use the Lexicon to enter a provisional diagnosis for new consult
requests.
- Fill in a Reason for Request.
Sites can help users by putting in
predetermined boilerplate text, text with TIU objects, and/or it could be
linked to a template that users can fill out. Users can then add to the text
already present. Or the field may be left blank for the user to fill in the
reason. However, a reason for request is required and the consult cannot be
saved without a reason for request.
- Select Accept Order.
- If finished ordering consults for this
patient, select Quit.
You may sign the order now from the
Orders tab or wait until later.
Requesting a New Procedure from the Consults Tab
To request a new procedure from the Consults tab, complete
the following steps:
- Select the Consults Tab.
- Select the New Procedure button.
- If the Provider & Location for Current Activities dialog opens,
fill in contact information, and select OK.
- Locate and select the procedure in the
Procedure list.
When you select the Consult Service or Specialty, several
things may happen:
o
If the service has
some prerequisites, a dialog will display stating what those are and will allow
you to print the information, continue to place the consult order, or cancel
the order.
o
In addition, any
predefined text or template will display to help the user fill out the Reason
for Request field.
o
The Provisional
Diagnosis field becomes active as well.
- Select the urgency from the Urgency field.
- Select an individual from the Attention
field.
Note: To help you distinguish between
providers, CPRS displays their titles (if available). When two or more
providers have identical names, CPRS also displays:
o
The service/section
and site division (if any) associated with these providers; site divisions are
displayed based on the following rules:
●
When no division is
listed for a provider, no division is displayed.
●
If only one division
is listed, this division is displayed.
●
If the site has
multiple divisions or more than one division is listed and one of these listed
divisions is marked as Default, CPRS displays the division marked as Default.
●
If more than one
division is listed for a provider and none is marked as Default, CPRS does not
display division information for this provider.
o
Providers who are
listed in the New Person file as Visitors are screened out from the provider
list. (These screened-out providers are listed as Visitors because their
entries were created as a result of a Remote Data View.)
- If needed, designate a different Clinically
Indicated Date.
Note: The Clinically Indicated Date field does not
apply to Prosthetics consults services, and the field is not available when the
user selects a Prosthetic service. If necessary, select a service that will
perform the procedure by using the down arrow to open the list and then
selecting the service.
Often, the service is already defined. However, sometimes,
the user has the chance to choose.
- Select whether the patient is an inpatient or outpatient.
- Select a place of consultation from the Place of Consultation
drop-down list.
- Enter a provisional diagnosis in the
Provisional Diagnosis field.
For each procedure, this field is either set up to require
that
o
the user type in an
answer (the box will be white and the Lexicon button unavailable), or
o
the user must select a
response must be from the Lexicon (the field will be yellow and the Lexicon
button is available).
●
CPRS will search for diagnoses
that contain the search term. The matching terms will display in the bottom
portion of the Problem List Lexicon Search dialog. The search now looks for
SNOMED Concepts Terms (SNOMED CT) items. Most items will also be mapped to an
ICD-9-CM code. The list will show the SNOMED concept text, the SNOMED code, and
the ICD-9-CM code if the term is mapped to one.
●
If you do not see the
appropriate problem listed, select the Extend Search button. On the Consults
tab, the Extend Search button extends the search to the ICD-9-CM clinical
hierarchy to find additional terms.
Note: If a user tries to enter a diagnosis with an inactive code,
CPRS will bring up a message indicating that the code must be changed and
giving the user the chance to choose a diagnosis with and active code.
o
Beginning on October
1, 2014, CPRS will use ICD-10-CM codes when providers use the Lexicon to enter
a provisional diagnosis for new procedure requests.
- Enter a reason for
this request in the Reason for request field.
Sites can help users by putting in predetermined boilerplate
text, text with TIU objects, and/or it could be linked to a template that users
can fill out. Users can then add to the text already present. Or the field may
be left blank for the user to fill in the reason. However, a reason for request
is required and the consult cannot be saved without a reason for request.
- Select Accept Order. Enter another order
-or-
select Quit.
Note: The order
must be signed before it is sent. You can either sign the order now or wait
until later.
Forwarding a Consult
At times, a clinician or service might receive a consult and
decide that the consult should be done by someone else. In this case, the user
can forward the consult to the appropriate user. To forward a consult, the user
can enter the following criteria
o
The service to which
the consult should be sent (required)
o
Any needed comments
(optional)
o
The Urgency (required)
o
When the action is
taken (optional , Now is default)
o
Who is responsible for
the action (who made the decision to forward the consult—required)
o
To whom the consult
will be forwarded, if known (optional)
From the Forward Consult dialog, the
user enters the necessary information to send the consult to a more appropriate
service or person
Note:
If the provider has an NPI, it will display on the screen above. See the "National Provider Identifier
(NPI) Display in CPRS section for an example of an NPI displaying on a screen.
To forward a consult, use these steps:
- If not already on it, go to the Consults tab by selecting the tab
or choosing View | Chart tab | Consults (or Ctrl + t).
- In the Forward Consult dialog under To service, select the consult
service to which the consult will be sent. Type in some letters in the
service name and scroll to find it, and use the plus sign to expand
grouper items.
- Add comments if needed.
- Select the Urgency from the drop-down list.
- Select the date and time of the action (forwarding). The default is
Now.
- Select the Responsible Person (the person who made the decision to
forward the consult.) This is a required field.
- In the Attention field, select the name of
the person to whom the consult should go, if known. Otherwise, this can be
left blank.
HCP RAS Consult Communication Error Message
The Austin FSC Healthcare Claims
Processing (HCP) Referral & Authorization System (RAS) depends on specific
text elements appearing in certain consult templates. If these templates are
modified by a site, the messaging between RAS and VistA Consults/Request
Tracking can be disrupted.
In Consults, a MailMan error message
is generated when there is a communication issue between RAS and VistA. This
message has been improved to include the HCPS support mail group as a
recipient. In addition, the message body will now include the consult number
and facility name from where the consult originated. These new elements will
assist HCPS support with more rapid resolution of communication errors.
COMMUNITY CARE Direct Schedule or Administrative
Consults
CPRS users who hold the security key OR ADMIN RBP TO CC are
able to create and release a Community Care direct schedule or administrative
consult order without possessing the ORES provider security key. The consult
service order will start with Community Care (case-insensitive), and contain
either –DS or –ADMIN
(case insensitive).
The consult order will be auto-signed as "Administratively Released
by Policy" and released to the service as soon as the order has been
accepted. The consult order will appear on the Orders tab with status
"pending".
Ordering a COMMUNITY CARE –DS or ADMIN Consult Using the
ADMIN Key:
1.
On Consults tab of
CPRS, click on New Consult. The Provider & Location for Current Activities
dialog box displays.
2.
Select a provider from
the Encounter Provider section.
3.
From the New Visit
tab, select a location from the Visit Location section.
4.
Click OK. The Order a
Consult dialog box displays.
Note: If a provider has an NPI, it will display on the screens
listed in instructions #1 and #4 above. See the "National Provider
Identifier (NPI) Display in CPRS section for an example of an NPI displaying on
a screen.
5.
From the Consult to
Service/Specialty section, select the Community Care Direct Schedule or
Administrative specialty required. A consult template displays.
6.
Complete the consult
template.
7.
Click OK. The
completed fields display in the Reason for Request of the Consult Order Dialog.
8.
Complete all required
order dialog fields.
9.
Click Accept Order.
The consult is created on the Consults tab of CPRS.
10.
Select the Orders tab in CPRS. The new order will
show as pending in bold or unreleased in blue.
11.
Click File>Refresh
Patient. The Review/Sign Changes dialog box displays.
NOTE: Select New Patient and Review/Sign Changes will also cause
this dialog box to display, as would exiting CPRS.
12.
Click OK to refresh
the screen. The Status column now displays as pending and is no longer bold
font.
NOTE: There are some users that hold both the OR ADMIN RBP TO CC
and the OREMAS security keys. In this case the Review/Sign Changes dialog box is slightly different.
13.
Select the Hold until
Signed radio button.
14.
Click OK to refresh
the screen.
Discontinuing a COMMUNITY CARE -DS or
-ADMIN Consult with the Admin Key:
|
|
Discontinuing a Consult should always be done on the
Consults tab. NEVER ATTEMPT TO DO THIS ON THE ORDERS TAB
|
1.
From the Consults tab in CPRS, click on the
consult in the left-hand panel to select it.
2.
From the Action menu,
select Consult Tracking, and then Discontinue. The Discontinue Consult:
Comments dialog box displays.
3.
In the Discontinue
Consult dialog box, enter comments in the Comments field.
4.
Click OK. The consult detail now shows that
the consult has been discontinued.
NOTE: The Admin Key can be
used in conjunction with other security keys and there are several scenarios
for this process. To see detailed steps
to create and discontinue Community Care -DS and -ADMIN consults see Admin Key
Training Guide (VDL>CPRS: Consult/Request Tracking>oc_adminkey_tg.docx).
Unique Consult ID (UCID) Display
When a user clicks on a Consult Order on the CPRS Orders
tab, and right-clicks to show the Order Details, the display will now show the
Unique Consult ID (UCID) which is in file #123 (REQUEST/CONSULTATION) in field
#80 (UNIQUE CONSULT ID). The UCID is a tracking number used by Community Care.
Also, when a user clicks on the Consult detail on the CPRS
Consults tab, the UCID will display:
Note: Display of
the surgery tab is controlled by the parameter ORWOR SHOW SURGERY TAB, which
can be set at the User, Division, or System level.
Depending on the configuration of your site and your access
permission, the CPRS Surgery tab may be visible. The Surgery tab allows you to
view signed operative reports generated in the VistA Surgery package. These
reports include the Operation Report, Nurse Intraoperative Report, Anesthesia
Report, and Procedure Report (Non-O.R.).
The following graphic shows the icon legend and the various
icons on the Surgery tab and their meanings.
This
tab of the icon legend defines the surgery icons
To view a surgery report, follow these steps:
1.
Select the Surgery tab.
2.
Select a report title
from the All Surgery Cases section of the window. Click the “+” sign to expand
a heading (if necessary).
3.
The text of the report
will be displayed in the right side of the window.
Note: If the provider has an NPI, it will not display on the screen
below
A report displayed on the CPRS
Surgery tab
To search a surgery report for specific text, follow these
steps:
1.
Select the Surgery tab.
2.
Select a report title
from the All Surgery Cases section of the window.
3.
Right-click in the
right-hand section of the window.
4.
Select Find in
Selected Document.
5.
Type in the text you
wish to find in the “Find what” field of the Find dialog box.
6.
Select Find Next.
7.
The appropriate text
will be highlighted if it is found in the surgery report.
To find specific text in a surgery
report, right-click in the right-hand section of the window
Customizing the Surgery Tab
You can limit the surgery cases that appear on the Surgery
tab. You can specify that only surgery cases from a specific date or date range
appear on the tab, or you can specify that all available surgery cases appear.
To limit the surgery cases displayed to a specific date
range, follow these steps:
1.
Select the Surgery tab.
2.
Select View | Custom
View.
The List Selected Cases dialog box
appears.
The List Selected Cases dialog
3.
Select a beginning
date by selecting in the appropriate field and doing one of the following:
o
entering a date (e.g.
6/21/01 or June 21, 2001).
o
entering a date
formula (e.g. t-200).
o
pressing the button to bring up a calendar.
4.
Select an ending date
by selecting in the appropriate field and doing one of the following:
o
entering a date (e.g.
6/21/01 or June 21, 2001).
o
entering a date
formula (e.g. t-200).
o
pressing the button to bring up a calendar.
5.
Enter a maximum number
of occurrences in the Max Number to Return field.
6.
Select a surgery case
sort order (ascending or descending).
7.
Select a category to
group the surgery cases by (from the Group By dropdown list).
8.
Select a case report
sort order (ascending or descending).
9.
Select a category to
sort case reports by (from the Sort By drop-down list).
10.
Select OK.
11.
The appropriate
surgery cases will appear in the left side of the screen.
12.
Click the “+” sign to
expand a heading (if necessary).
To view all the surgery cases for a patient, follow these
steps:
1.
Select the Surgery
tab.
2.
Select View | All
Cases.
Signing a Surgery Report
Depending on the configuration of your site and your access
permission, you may be able to sign certain surgery reports.
To sign a surgery report, follow these steps:
- Select the Surgery tab.
- Select a surgery report from the All Surgery Cases section of the
window.
- Select Action | Sign Report Now…
-or-
right click in
the right-side of the window and select Sign
Report Now.
- Enter your electronic signature code.
- Select Sign.
Creating Surgery Report Addenda
Depending on the configuration of your site and your access
permission, you may be able to make addenda to certain surgery reports.
To make an addendum to a surgery report, follow these steps:
1.
Select the Surgery tab.
2.
Select a surgery
report from the All Surgery Cases section of the window.
3.
Select Action | Make
Addendum…
4.
Type the text for the
addendum.
Discharge Orders are sets of orders to be placed for a
patient when checking out of the hospital. The Discharge Summary tab gives you
quick access to the Discharge Summary
for a specific patient. The list of documents in the D/C Summ tab is in
a tree structure instead of a simple list. Highlight any discharge summary
listed in the left field to view the text of the summary in the right field.
Addenda are separately selectable and are displayed as a page with a plus sign
behind a note page (See highlight below.) Discharge Summaries with Addenda have
a clickable plus sign. Hold the mouse pointer over a listing to see the entire
line of the listing. The Discharge Summary that is highlighted is displayed on
the right.
Right-click in the Discharge Summary text and you may select
the “Find in Selected Summary” option from the popup menu. This option allows
you to search the displayed text. A “Replace Text” option is also available,
but it is only active when a discharge summary is being edited.
Click the View and Action menus to see the available
options. Double click the plus sign to expand the list. Once expanded, any
discharge summary may be selected and viewed.
You can also click the New Summary button to create a
Discharge Summary. You may also have to enter encounter information if the
visit has not been defined.
Discharge
Summaries are listed on the D/C Summ tab
Select a grouping node (for example "All signed
notes") in the tree to display a second list of all the documents falling
under that grouping node. This second list can be sorted by clicking on the
column headings (Date, Title, Author, Location).
Changing Views on the Discharge Summaries Tab
Changing the view of the Discharge Summary tab allows you to
focus the list of summaries on one of several criteria. Focusing the list will
speed up the selection process.
You may change the Discharge Summaries List view to only
include the following summaries:
●
Signed Summaries (All)
●
Signed Summaries by
Author
●
Signed Summaries by
Date Range
●
Uncosigned Summaries
●
Unsigned Summaries
To change the view, click View on the menu and select the
desired list items.
The Custom View dialog (View
| Custom View) has been greatly expanded, allowing the items in the tree to
be grouped and sorted in a variety of ways. All custom view selections can be
saved as the user's default view (View |
Save as Default View).
Note: If the provider has an NPI, it will display
on the screen below. See the
"National Provider Identifier (NPI) Display in CPRS” section for an
example of an NPI displaying on a screen.
The
List Selected Documents dialog
To view a discharge summary, use
these steps:
- Select the D/C Summ tab.
- Select the summary in the list box.
- To sort the list, select View and the appropriate choice below:
●
Signed Summaries (All)
●
Signed Summaries by
Author
●
Signed Summaries by
Date Range
●
Uncosigned Summaries
●
Unsigned Summaries
●
Custom View
Note: To set one of these views as the
default, select View | Save as Default.
- Locate the summary and select it.
Writing Discharge Summaries
You can enter discharge summaries through CPRS. The document
templates and TIU titles that your site can create should make creating these
documents much faster and easier.
To write a discharge summary, use these steps:
- Select the D/C Summ tab.
- Select New Summary or select Action | New
Discharge Summary.
Note: If this visit is undefined, CPRS prompts for encounter type
and location, clinician, date and type of visit, such as Ambulatory, Telephone,
or Historical.
- In the Discharge Summary Properties dialog, select Discharge
Summary Title (e.g., General, SOAP, Warning, etc.). Additional items will
appear on the dialog for titles that require entry of a cosigner or an
associated consult.
- If necessary, change the note date by clicking the button next to
the date and entering a new date.
- If necessary, change the note author by
selecting the author from the Author drop-down list.
Note: To help you distinguish between providers, CPRS displays
their titles (if available). When two or more providers have identical names,
CPRS also displays:
o The service/section and
site division (if any) associated with these providers; site divisions are
displayed based on the following rules:
● When no division is listed for a provider, no division is
displayed.
● If only one division is listed, this division is displayed.
● If the site has multiple divisions or more than one
division is listed and one of these
listed divisions is marked as Default, CPRS displays the division marked as
Default.
● If more than one division is listed for a provider and none
is marked as Default, CPRS does not display division information for this
provider.
o Providers who are listed
in the New Person file as Visitors are screened out from the provider list.
(These screened-out providers are listed as Visitors because their entries were
created as a result of a Remote Data View.)
- Enter the attending physician.
- Select the admission related to this Discharge Summary.
- Enter any additional information, such as
an expected cosigner. Completing these steps will allow the note to be
automatically saved.
Note: For a Discharge Summary, if a
user requires a cosigner (such as a student or other type of clinician), that
user’s name should not appear in the list of potential cosigners. Also,
occasionally a problem occurs if a cosigner’s access lapses and they have become
“disusered.” If this occurs, you can click OK and proceed with that selection
or click Cancel and choose another cosigner.
1.
Select OK.
2.
Create the summary
content by typing in text, copying and pasting, and/or inserting templates into
the document.
3.
Select the template
drawer if it is not open.
4.
Locate the appropriate
templates.
5.
Double-click the
template (You can also drag-and-drop or right-click the template and select
Insert Template) and modify as needed.
6.
When finished entering
text, you may (optional) right-click in the text area and select Check Spelling
and Check Grammar.
7.
When complete, decide
when you will sign the summary and choose the appropriate option.
8.
Click Add to Signature List (to place it with
other orders or documents you need to sign for this patient). You can also
click Save Without Signature or Sign Discharge Summary Now to sign the summary
immediately.
On the Labs tab, you can view the results of lab tests that
were ordered for a selected patient. Ordering of lab tests is performed on the
Orders tab. The Cover Sheet tab displays results of some of the patient’s most
recent orders. Some of the lab reports are also found on the Reports tab. The
fields on the left side of the Labs tab list available lab results. For some
reports, you may need to specify a date range or other criteria. Some reports
will prompt for specific tests to be displayed.
Note: If the
provider has an NPI, it will not display on the screen below.
The
Labs tab
Display of Laboratory Test Results
Through CPRS, you can review lab test results in many
formats. Based on user feedback, CPRS has made some changes to the Labs tab
display, including adding two new reports, replacing one report, a new order
for items in the Lab Results pane, and some changes to the display of the
reports.
New Reports
Two new items have been added:
●
Lab Overview
(Collected Specimens)
●
Pending Lab orders.
Changed Report
The Lab Status report has been replaced by the Lab Orders
(All) report.
New Order for Items in the Lab Results Pane
With CPRS version 30.B, the order of reports in the Lab
Results pane, where the users select which lab report they want to view, is
different. The two new reports will be the top two items listed—unless your
site has customized the order of the items.
Order of Items before v.30.B:
●
Most Recent
●
Cumulative
●
All Tests by Date
●
Selected Tests by Date
●
Worksheet
●
Graph
●
Microbiology
●
Anatomic Pathology –
All Reports
●
Blood Bank
●
Lab Status
Nationally Released Order of Items after 30.B
●
Lab Overview
(Collected Specimens)
Note: The first item in the list could be different
at your site. A new parameter enables sites to set which report they want to
appear first in the list. This will also affect the data that displays when the
user first goes to the Labs tab.
●
Pending Lab Orders
●
Most Recent
●
All Tests by Date
●
Selected Tests by Date
●
Worksheet
●
Graph
●
Microbiology
●
Anatomic Pathology –
All Reports
●
Blood Bank
●
Lab Orders (All)
●
Cumulative
Note: Items in bold have changed order. The two
new reports are the first two items in the list and Cumulative has moved to the
bottom. Lab Orders (All) is new and replaces the Lab Status report.
New Date Range Selection Buttons
CPRS has two ways to select the date range for Lab reports.
The first way is by using the date pane in the lower left corner of the labs
tab when a report is selected as shown below. In this screen capture, the
nationally released order for the reports is displayed in the Lab Results
pane.
The second way, added with CPRS GUI v.30.B, enables sites to
set a parameter to instead have the date ranges set using radio buttons above
the main data pane. In the screen capture below, the parameter to have a
different report at the top of the Lab Results pane has also been set.
Note: If the
provider has an NPI, it will not display on the screen below.
Viewing Laboratory Test Results
To view lab test results, use these steps:
- Select the Labs tab.
- In the Lab Results pane, select the type of
results you want to see.
For some selections, you must
determine which test results you want to see. If the Select Lab Test dialog
appears, you need to choose the tests you want to see.
- If necessary, select the tests for which you want to see the
results.
- Also, you may need to choose a date range
(Today, One Week, Two Weeks, One Month, Six Months, One Year, Two Years,
or All Results.)
Lab Order (Collected Specimens)
The Lab Order (Collected Specimens) report will show which
Lab Order have been collected.
Pending Lab Orders
This report shows items that are pending so that healthcare
givers will know what lab orders are pending so that others are not
ordered.
Most Recent
On the Labs tab, the Most Recent shows the latest lab test
and allows the user to move back through the most recent results or items
collected. In this dialog, the most recent lab data are listed in the pane. The
provider uses four buttons to move to the Oldest, Previous, Next, and Newest.
The test’s collection date and time (if there is one) is displayed as the first
item in the list. It also displays microbiology results and any comments on the
collection.
Note: Some lab tests can have a collection date but
no collection time. In this case, CPRS displays on the date between the
Previous Collected and Next buttons.
Each test then displays the following:
●
The Collection
Date/Time
●
Test name
●
Result/Status
●
Flag (L for abnormal
low, H for abnormal High, and each may have an asterisk (*) if the result is
critical)
●
Units
●
Reference range
Additional information includes the specimen type, accession
number, and the provider who ordered the lab test, the report release date and
time, and the name of the lab performing the test.
Clicking on a lab test will display a
graph for all results of that particular test.
Note: If the
provider has an NPI, it will not display on the screen below.
The
most recent lab data are displayed for the selected patient
Worksheet
The Worksheet is similar to the Selected Test by Date
report. It does not display microbiology results, but it has many features for
viewing lab results. It is very useful for displaying particular types of
patterns of results.
Tests can be selected individually or by test groups. Any
number of tests can be displayed. When selecting a panel test, such as CBC, the
panel will be expanded to show the individual tests. Tests can be restricted to
only display results for a specific specimen type. For example, displaying
glucose results only on CSF can be accomplished by selecting the specimen CSF
and then selecting the test Glucose.
Test groups allow you to combine tests in any manner. For
example, a test group could combine CWBC, BUN, Creatinine, and Platelet count.
You can save those test groups for later use. You can also select test groups
that other users have created. You cannot exchange or delete other’s test
groups, only your own. Test groups are limited to seven tests, but you may have
an unlimited number of test groups. To define your own test groups, select
those tests you want and click the New button. If more than seven tests are
selected, the New button will be disabled. If you want to delete a test group,
deselect it and click the Delete button. If you want to replace an existing
test group with other tests, select the test group, make any changes to the
tests to be displayed and click the Replace button.
Note:
These test groups are the same as those
you may have already created using the Lab package. The seven-test restriction
is a limitation of the Lab package.
Note: If the
provider has an NPI, it will display on the screen below. See the "National Provider Identifier
(NPI) Display in CPRS” section for an example of an NPI displaying on a screen.
The
Select Lab Tests dialog
The Worksheet display is a table of results that can be
displayed vertically or horizontally. Since only results are displayed in a
table, comments are footnoted with a ** and shows in the panel below the table.
You can filter the results to only show abnormal values. This will quickly show
tests that have results beyond their reference values.
Lab
results displayed on a worksheet
You can toggle between view comments and graph view. The
graph format displays each test separately. By selecting each test, you see the
trend in values for each time range. You may also use features to Zoom, apply
3D, and display values on graph. Zooming is allowed when checking the Zoom
check box. You may then click the graph and drag a rectangular area to zoom in
on. To undo the zoom feature, you can uncheck the Zoom check box or drag a
rectangular area in the upper left corner of the graph and then release the
mouse button.
Note: Zoom will retain the selected date range when
you change to other tests or test groups. This is helpful when you are looking
for trends within a given time period.
A right-click on the graph will bring up a pop-up menu with
other actions. You can display details of the lab test by right-clicking a
point on the graph and then selecting Details. This will display all test
values for this collection time. Right clicking on the graph will display all
values for the selected test.
Glucose
(Serum) levels displayed on a graph
Graph
Selecting the Graph option brings up CPRS graphing in a
separate window. For more information about graphing, please see CPRS Graphing.
All Tests by Date
This report displays all lab results (except anatomic
pathology and blood bank). The data is displayed in the order of the time of
collection.
Note: If the
provider has an NPI, it will not display on the screen below.
All
lab tests are listed by date
Selected Tests by Date
This report is useful when you only wish to review only
specific tests. Microbiology results can also be selected. You will be prompted
to select any lab tests. For example, if you select CBC, Chem 7, Lithium, and
Liver Profile, only the results for those tests would be displayed.
Note: If the
provider has an NPI, it will not display on the screen below.
Test
results are displayed for one year
Microbiology, Anatomic Pathology, Blood Bank
These reports display only the results from these portions
of the laboratory.
Lab Orders (All)
The Lab Order (All) report displays the status on current
orders.
Cumulative
The cumulative report is the most
comprehensive lab report. It displays all of the patient’s lab results. When
selecting a large data range, this report may take some time before being
displayed. The results are organized into sections. You can automatically
scroll to that section by selecting it in the Headings list box.
Note: If the
provider has an NPI, it will not display on the screen below.
Cumulative
lab results are displayed on the Labs tab
Changing Views on the Labs Tab
The View menu on the Labs tab is different from most of the
other tabs in that the menu options do not sort or focus the listed items. The
menu items are a way to open different windows and displays with information
the clinician may need to see in conjunction with the lab results.
Demographics
From the Labs tab, click View | Demographics to display the
Patient Inquiry screen of the currently selected patient.
Note: If the
provider has an NPI, it will not display on the screen below.
The
Patient Inquiry screen displays demographic data for a patient
Postings
From the Labs tab, click View | Postings to display the
Patient Postings screen of the currently selected patient. The Patient Postings
windows displays information about the patient’s allergies, and any Crisis
Notes, Warning Notes, and Directives that may apply to the patient.
The
Patient Postings dialog displays Allergies, Crisis Notes, Warning Notes, and
Directives, Lactating or Pregnant
Reminders
From the Labs tab, click View | Reminders to display the
Available Reminders dialog for the currently selected patient. The Available
Reminders dialog allows you to review all reminders including the ones that
apply to the currently selected patient.
A
patient’s available reminders are displayed on the Available Reminders dialog
Currently, you can print reports from the Problems,
Consults, Labs, Notes, Discharge Summary, and Reports tabs to any VISTA printer defined on the server or to a
Windows printer.
You can also now print graphics on a Windows printer from
the Labs tab and the Vitals screen. You can use File | Print Setup... to set up a preferred printer for the current
session and save it as the default for the user.
The dialog box shown below comes up when you select File | Print from the Notes tab. A
similar dialog, without the Chart copy / Work copy option appears for items on
other tabs. Many report boxes now have Print button on them to make it easier
for you to print the information you need. With most reports you can select a
date range and sub-topics to customize your reports.
The
Print dialog
Normally, you do not need to enter a right margin or page
length value. These values are measured in characters and normally are already
defined by the device. You will also still have the options to print your
regular tasked jobs.
Viewing a Report
To display a report, follow these steps:
- Select the Reports tab.
- See if the text on the Remote Data button is blue. If the text is
blue, the patient has remote data.
- To view remote data, which may include Department of Defense data,
click the Remote Data button to display a list of sites that have remote
data for the selected patient. If you do not want remote data, skip to
step 5.
- Select All if you want data from all the
sites listed or click the check box in front of the site names you want to
view remote data from and close the Remote Data button by clicking the
button again.
Note: If
there is a problem getting the remote data, the following messages should give
the user some feedback. For text reports only, CPRS adds a comment that
describes the problem where the report would normally be. For ‘grid’ type
reports, the error comment is put in the first column (after the facility name)
of the report. Information is also included when the Remote Data button is used
to display the list of sites that have data.
o
<No HDR Data
Included> - Use “HDR Reports” menu for HDR Data.
o
<No HDR Data> -
This site is not a source for HDR Data.
o
<No DoD Data> -
Use “Dept. of Defense Reports” Menu to retrieve data from DoD.
o
<ERROR> - Unable
to communicate with Remote site
- Select the report you want to view from the
Available Reports box (click the "+" sign to expand a heading).
Note: The next section,
“Available Reports on the Reports Tab,” lists the location of each report when
they are exported. The list is configurable and your list may be different.
Choosing
a Department of Defense (DoD) report does not limit you to DoD data. For
example, if you choose Microbiology under Dept. of Defense, you will get DoD
data and remote VA data. You do not have to run a separate report to get VA
data.
- If necessary, select a date range from the
Date Range box located in the lower left corner of the screen.
The report should be displayed either after step 5 or step
6. You can then scroll through and read the report. If the report is in tabular
form, click a row to reveal details about that row. (To select more than one
row, press and hold the Control or Shift key.)
Note: If the
provider has an NPI, it will not display on the screen below.
The
All Outpatient Medications report is displayed on the Reports tab
Available Reports on the Reports Tab
The table below lists the reports available from the Reports
tab. A “+” sign indicates that the topic is a heading that can be expanded.
Some of these reports may have remote data.
In the list below, those reports that may have remote data
from the Department of Defense are noted. Also, there is a part of the tree
that lists Department of Defense reports.
Note: A new Consults (DoD remote data only) report
has been added under
Department of Defense (DoD) in the reports tree view. This
report has only DoD data. Unlike other items under the Department of Defense
heading, this report has no VA data.
Another new addition to the Reports tab tree view is the HDR
(Health Data Repository) section that contains four items: Allergies, Chem
& Hematology, Vital Signs, and Pharmacy All Outpatient.
Note: In the vitals data from DoD through
Bidirectional Health Information Exchange (BHIE), CPRS receives only one
circumference/girth measurement: the head circumference. Unfortunately, it is
not labeled as a “head” circumference, and it is only measured in inches. So,
if a provider sees a circumference/girth from a DoD site, the provider should
recognize that it is a head circumference measured in inches.
Other changes are the inclusion of modifiers and qualifiers
(flow rate, oxygen concentration, and methods) for Pulse Oximetry, and in the
HDR All Outpatient Pharmacy report, any set of results that has a SIG with a
length greater than 60 characters will show “[+]” in the corresponding column.
Note: These items are currently inactive until HDR
data is ready and sites receive instruction to begin using HDR data. If the
user selects one of these items, CPRS will display the following dialog.
This
dialog will display if the HDR is inactive
Please note that the order of the reports may be different
depending on the configuration of your site. This list is exported from CPRS.
o
Clinical Reports
● Allergies (can contain remote data from Department of
Defense)
o
Patient information
● Demographics
● Insurance
● Disabilities
o
Visits / Admissions
● Adm./Discharge
● Expanded ADT (can contain remote data from Department of
Defense)
● Discharge Diagnosis
● Discharges
● Future Clinic Visits
● Past Clinic Visits
● ICD Procedures
●
ICD Surgeries
● Transfers
● Treating Specialty
● Comp & Pen Exams
o
Dietetics
● Generic
● Diet
● Nutritional Status
● Supp. Feedings
● Tube Feeding
● Dietetics Profile
● Nutritional Assessment
● Discharge Summary (can contain remote data from Department
of Defense)
o
Laboratory
● Blood Availability
● Blood Transfusion
● Blood Bank Report
● Anatomic Pathology (can contain remote data from Department
of Defense)
● Lab Orders (can contain remote data from Department of
Defense)
● Chem & Hematology (can contain remote data from
Department of Defense)
● Microbiology (can contain remote data from Department of
Defense)
o
Medicine/CP
● Abnormal
● Brief Report
● Full Captioned
● Full Report
● Procedures (local only)
● Procedures
o
Orders
● Orders Current
● Daily Order Summary
● Order Summary for a Date Range
● Chart Copy Summary
o
Outpatient Encounters
/ GAF Scores
● Education
● Education Latest
● Exam Latest
● GAF Scores
● Health Factors
● Immunizations
● Outpatient Diagnosis
● Outpatient Encounter
● Skin Tests
● Treatment Provided
o Pharmacy
● All Medications
Note: The All Medications report includes All Inpatient and
Outpatient Pharmacy data for a patient. The user can limit the data in the
report by using date range parameters. To determine the data that is included,
based on date range selection, the logic first looks for Last Fill Date, then
Issue Date, then Order date (depends on if the date exists for the drug/RX being screened).
The report is initially sorted by
STATUS, beginning with Active, followed by Discontinued, followed by Expired
(alphabetically within each of those three groups). Users can also sort the by
selecting a column header, thus sorting by that column.
● Active Outpatient
● Outpatient Medications (can contain remote data from
Department of Defense)
Note: This report was previously called All Outpatient, but has
been changed to Outpatient Medications because the user can now set a date
range instead of getting all data for the patient. To determine the data that
is included, based on date range selection, the logic first looks for Last Fill
Date, then Issue Date, then Order date (depends on if the date exists for
the drug/RX being screened).
● Outpatient RX Profile
● Active IV
● All IV
● Unit Dose
● Med Admin History (BCMA)
● Med Admin Log (BCMA)
● Herbal/OTC/Non-VA Meds
●
Women’s Health:
Potentially Unsafe Medications
●
Active Meds With
Allergies
Note: The Active Meds With Allergies report displays all “Active”
Pharmacy related Orders which have an interaction with an entered allergy for
the patient.
o
Problem List
● Active Problems
● All Problems
● Inactive Problems
o
Progress Notes
● Progress Notes
● Advance Directive
● Clinical Warnings
● Crisis Notes
o
Radiology
● Report (can contain remote data from Department of Defense)
● Status
● Imaging (local only)
● Imaging
● Surgery Reports
● Vital Signs
o Health Summary
● Adhoc Report
● Ac Clinical Summary
● Discharge Summary
● Radiology
● Pain Management
● Remote Demo/Visits/Pce (1y)
● Remote Demo/Visits/Pce (3m)
● Remote Clinical Data (1y)
● Remote Clinical Data (3m)
● Remote Clinical Data (4y)
● Remote Oncology View
● Remote Oncology View
● Global Assessment Functioning
o
HDR
● Allergies
● Chem & Hematology
● Pharmacy All Outpatient
● Vital Signs
o
Department of Defense
Reports
● Allergies (contains only remote data from DoD and VA)
● Expanded ADT (contains only remote data from DoD and VA)
● Consults (contains DoD remote data only)
● Discharge Summary (contains only remote data from DoD and
VA)
o
Histories (contains
DoD remote data only)
● Family History
● Social History
● Other Past Medical History
o
Laboratory
● Lab Orders (contains only remote data from DoD and VA)
● Chem & Hematology (contains only remote data from DoD
and VA)
● Surgical Pathology (contains DoD remote data only)
● Cytology (contains DoD remote data only)
● Microbiology (contains only remote data from DoD and VA)
● Outpatient Encounter (contains only remote data from DoD
and VA)
● Outpatient Medications (contains only remote data from DoD
and VA)
● Progress Notes (contains only remote data from DoD and VA)
● All Problem List (contains only remote data from DoD and
VA)
● Questionnaires (DOD Remote data only)
● Radiology Report (contains only remote data from DoD and
VA)
● Vital Signs (contains only remote data from DoD and VA)
o
Imaging (local only)
o
Lab Status
o
Blood Bank Report
o
Anatomic Pathology
● Autopsy
● Electron Microscopy
● Surgical Pathology
o Dietetics Profile
o
Nutritional Assessment
o
Vitals Cumulative
o
Procedures (local
only)
o
Daily Order Summary
o
Order Summary for a
Date Range
o
Chart Copy Summary
o
Outpatient RX Profile
o
Med Admin Log (BCMA)
o
Med Admin History
(BCMA)
o
Surgery (local only)
o
Event Capture
● Patient PCE Summary
● Patient Data Summary
Sorting a Report (Table View)
If a report is available in a table view, the table can be
sorted alphabetically, numerically, or by date.
To sort data in a report table:
- Select the column heading you wish to sort by.
- The table will be sorted alphabetically (A-Z), numerically (0-9),
or by date (most recent-least recent).
- If you click the column heading again, the table will be sorted in
inverse order (Z-A, 9-0, or least recent-most recent).
- To perform a secondary sort, click another
column heading.
Note: If you hold the pointer over the table, a hover hint will
appear with the criteria used to sort the table.
Note: If the provider has an NPI, it will not display on the screen
below.
You
can easily sort report data in a tabular view
Graphing a Report
If graph reports are available at your site, you can display
them using the CPRS graphing functionality that is available on the Reports tab. You can also use Reports-tab graphing functionality to
graph items from the View or Item list. In fact, graphing functionality on the Reports tab offers the same set of view
and setup options you use when creating graphs from CPRS graphing’s detached
window. (For information about setting
up and using graphing functionality, see the “CPRS Graphing” section on p.106 of
this manual.) To display a graph report:
Click the graph report in the Available Reports list. CPRS automatically starts graphing
functionality on the Reports tab and
displays the graph report.
To launch graphing on the Reports tab without first
selecting a graph report:
• Click Graphing (local only) in the Available Reports
list.
Printing a Report
To print a report, follow these steps:
From the Reports
tab, select the report you would like to print. If the report is in text
format, right-click the text of the report
-or-
if the report is in table format, click the row that
contains the data you would like to print (to select more than one row, press
and hold either the Shift or Control key). After you have selected
the appropriate row(s), right-click the area or row you have selected.
Select Print
(text format) or Print Data From Table
(table format).
You
can print data from a table using the context that comes up by right-clicking
on the appropriate main report area or a data row and selecting the Print
option.
Copying Data from a Report
To copy data from a report, follow these steps:
- From the Reports tab, select the report you would like to copy data
from.
- If the report is in text format, select the
text you would like to copy and then right-click
-or-
if the report is in table
format, click the row that contains the data you would like to copy (to select
more than one row, press and hold either the Shift or Control key). After you
have selected the appropriate rows, right click the area or row you have
selected.
- Select Copy (text format) or Copy Data From Table (table format).
- You can now paste the data into another
area in CPRS or into another program.
You
can copy data from a report by right-clicking and selecting Copy
Viewing a Health Summary
Health Summaries provide important information to users
about a patient’s condition. With Remote Data Views (RDV), users may be able to
access remote Health Summary information from other facilities or the
Department of Defense (DoD). If the patient has DoD data, but it is not
available, CPRS will provide feedback for the text or grid type reports.
CPRS adds a comment that describes the problem where the
data from the remote report would normally be. For ‘grid’ type reports, the
error comment is put in the first column (after the facility name) of the
report. Here are some examples of the
comments that could show up, depending on the type of query and what the user
has selected:
•
<No HDR Data
Included> - Use “HDR Reports” menu for HDR Data.
•
<No HDR Data>
This site is not a source for HDR Data.
•
<No DoD Data> -
Use “Dept. of Defense Reports” Menu to retrieve data from DoD.
•
<ERROR> - Unable
to communicate with Remote site
In addition to this text, error
messages will also be shown after each remote site listed under the (blue)
Remote Data View button, when appropriate.
To display a Health Summary, follow these steps:
- Select a patient after you enter the CPRS system.
- Select the Reports tab.
- Under the Available Reports box on the left side of the screen,
click the “+” sign in order to expand the Health Summary heading.
- Select a Health Summary by clicking on the summary that you would
like to see. After you have
selected a summary, the appropriate data is displayed on the right side of
the screen.
- Use the scroll bar on the right to scroll
through the different sections of the Health Summary.
Appendix A – Accessibility for Individuals with
Disabilities
This appendix discusses the features of CPRS that allow
people who are blind, who have limited vision, or who have limited dexterity to
use the software effectively. The
features discussed include changing the font and window sizes, changing the
background color, configuring a screen reader, and keyboard equivalents for
common CPRS commands.
Changing the Font Size
CPRS supports 8, 10, 12, 14, and 18 point font sizes. Font
sizes larger than 18 point, make CPRS difficult for the user to navigate. If
the user requires font sizes larger than 18 point, then the use of font
magnification software, such as Windows Magnifier or other similar tools is
recommended.
Changing the size of the fonts used in CPRS is a two-step
process. The instructions in “CPRS
Windows and Dialog Boxes” will change the size of most of the fonts
displayed in CPRS windows and dialog boxes. However, to change the font size
used for CPRS menus and Windows alert boxes, you will also need to follow the
steps in “CPRS Menus and Windows Alert boxes.”
CPRS Widows and Dialog Boxes
You can adjust the font size for most windows and dialog
boxes that appear in CPRS. If you change the font size, some screen components
will be resized to fit the new font size.
If this occurs, you will need to manually resize some dialog boxes and
screen components. CPRS will save the
dimensions for the resized components so you will only have to resize them
once.
To change the font size for CPRS windows and dialog boxes,
follow these steps:
1. Select
Edit | Preferences | Fonts and
choose the appropriate font size. The font size will be changed.
Note: The menu fonts and alert box fonts will not be
changed until you follow the steps in CPRS Menus and Windows Alert boxes
(below).
CPRS Menus and Windows Alert Boxes
To change the font size used for CPRS menus and Windows
alert boxes, follow these steps:
Note: The steps below will change the font used in
menus and Windows boxes for ALL of the applications on your computer.
- Click Start | Settings | Control Panel.
- Double-click on the Display icon.
- Click the Appearance
tab.
- From the Item drop-down list box, select either Menu or Message
Box.
- Select a font from the Font drop-down list.
- Select a size from the Size drop-down list.
- Select a color from the Color drop-down list.
- Click Apply.
- If necessary, repeat steps 4-8 to change the display settings for
another item.
- Press OK.
Changing the Window Background Color
To change the background color of CPRS windows and dialog
boxes, follow these steps:
Note: The steps below will change the background
color of windows and dialog boxes for ALL applications on your computer.
1.
Click Start | Settings
| Control Panel.
2.
Double-click on the Display icon.
3.
The Display Properties dialog box will
appear.
4.
Click the Appearance tab.
5.
From the Item
drop-down list box, select Window.
6.
Select a color from
the Color drop-down list box.
7.
Click Apply.
8.
The Appearance tab of
the Display Properties dialog box
9.
If necessary, repeat
steps 4-6 to change the display settings for another item.
10.
Press OK.
In this example, the Window color
has been changed to a high contrast selection
Keyboard Shortcuts for Common CPRS Commands
Navigation
Select the Cover Sheet tab Ctrl + S
Select the Problems tab Ctrl + P
Select the Meds tab Ctrl + M
Select the Orders tab Ctrl + O
Select the Notes tab Ctrl + N
Select the Consults tab Ctrl + T
Select the D/C Summ tab Ctrl + D
Select the Labs tab Ctrl + L
Select the Reports tab Ctrl + R
Advance to the next field, button,
or control (left to right) Tab
To exit a field that accepts tabs
(e.g. the Note pane of the
Notes tab, the Reason for Request
field on a consult, the
Fields on the complex medication
form) and move to the
next control (left to right) Control + Tab
To exit a
field that accepts tabs and move to the
previous control (right to left) Shift + Control + Tab
Pull down a list box Down Arrow
Navigate a list box Arrow Up Arrow or Down
Select an item in a list box Return or Enter
Expand a tree view Right Arrow
Collapse a tree view Left Arrow
To advance (left-right) to the next
tabbed page of a dialog box Control + Tab
An
example of a dialog box with tabbed pages. Press Control + Tab to move from
left to right (from the Solutions tab to the Additives tab). Press Shift + Control + Tab to move from
right to left (from the Additives tab to the Solutions tab)
To move backwards (right to left)
between tabbed pages of a dialog
box Shift + Control + Tab
To toggle a
check box on or off Spacebar
Common Commands
File Menu
Select New Patient Alt-F-N
Display demographic information in
the Patient
Selection dialog box so it can be
read by a screen reader Ctrl + D
Refresh Patient Information Alt-F-I
Update Provider / Location Alt-F-U
Review/Sign Changes Alt-F-R
Next
Notification Alt-F-F
Remove Current Notification Alt-F-V
Print Setup Alt-F-S
Print Alt-F-P
Exit Alt-F-X
Edit Menu
Undo/Redo Ctrl + Z/Ctrl + Y
Cut Ctrl + X
Copy Ctrl + C
Paste Ctrl + V
Preferences | Fonts | 8 pt Alt-E-R-F-8
Preferences | Fonts | 10 pt Alt-E-R-F-1
Preferences | Fonts | 12 pt Alt-E-R-F-2
Preferences | Fonts | 14 pt Alt-E-R-F-4
Preferences | Fonts | 18 pt Alt-E-R-F-P
Preferences |
Fonts | 24 pt Alt-E-R-F-T
Help
Contents Alt-H-C
About CPRS Alt-H-A
Cover Sheet
View Menu
Demographics Alt-V-M
Postings Alt-V-P
Reminders Alt-V-R
Problems Tab
View Menu
Active Problems Alt-V-A
Inactive Problems Alt-V-I
Both Active/Inactive Problems Alt-V-B
Removed Problems Alt-V-R
Filters Alt-V-L
Show Comments Alt-V-C
Save as Default View Alt-V-V
Return to Default View
Alt-V-F
Action Menu
New Problems Alt-A-N
Change Alt-A-C
Inactive Alt-A-I
Verify Alt-A-V
Annotate Alt-A-A
Remove Alt-A-R
Restore Alt-A-S
View Details Alt-A-D
Meds Tab
View Menu
Details Alt-V-D
Administration
History Alt-V-H
Action Menu
New Medication Alt-A-N
Change Alt-A-C
Discontinue/Cancel Alt-A-D
Release Hold Alt-A-L
Hold Alt-A-H
Renew Alt-A-W
Copy to New Order Alt-A-P
Transfer to Alt-A-T
Refill Alt-A-E
Orders Tab
View Menu
Active Orders (includes pending,
recent activity) Alt-V-A
Current Orders (active/pending
status only) Alt-V-O
Auto DC/Release Event Orders Alt-V-V
Expiring Orders Alt-V-E
Unsigned Orders Alt-V-U
Custom Order View Alt-V-C
Save as Default View Alt-V-S
Return to
Default View Alt-V-R
Details Alt-V-D
Results Alt-V-L
Results
History Alt-V-H
Action Menu
Change Alt-A-C
Copy to New Order Alt-A-N
Discontinue / Cancel Alt-A-D
Change Release Event Alt-A-G
Hold Alt-A-H
Release Hold Alt-A-L
Renew Alt-A-W
Alert when Results Alt-A-A
Complete Alt-A-M
Flag Alt-A-F
Unflag Alt-A-U
Order Comments Alt-A-R
Sign Selected Alt-A-S
Options Menu
Save as Quick Order Alt-O-S
Edit Common
List Alt-O-E
Complex Tab of the Medication Order Dialog
Enter a field in a grid Spacebar
Insert a row in a grid Select
the row and then press Insert.
Delete a row in a grid Select
the row and then press Delete.
Drop down the
then/and list Spacebar
Notes Tab
View Menu
Signed Notes (All) Alt-V-S
Signed Notes by Author Alt-V-A
Signed Notes by Date Range Alt-V-R
Uncosigned
Notes Alt-V-C
Unsigned Notes Alt-V-U
Custom View Alt-V-M
Save as Default View Alt-V-V
Return to Default View Alt-V-F
Details Alt-V-D
Icon Legend Alt-V-I
Action Menu
New Progress Note Alt-A-N or Shift + Ctrl + N
Make Addendum Alt-A-M or Shift + Ctrl + M
Add New Entry to Interdisciplinary
Note Alt-A-W
Attach to Interdisciplinary Note Alt-A-T
Detach fm Interdisciplinary Note Alt-A-H
Change Title Alt-A-C
Reload Boilerplate Text Alt-A-B
Add to Signature List Alt-A-L
Delete Progress Note Alt-A-D or Shift + Ctrl + D
Edit Progress Note Alt-A-E or Shift + Ctrl + E
Save Without Signature Alt-A-A or Shift + Ctrl + A
Sign Note Now Alt-A-G or Shift + Ctrl + G
Identify
Additional Signers Alt-A-I
Options Menu
Edit Templates Alt-O-T
Create New Template Alt-O-N
Edit Shared Templates Alt-O-S
Create New Shared Template Alt-O-C
Edit Template
Fields Alt-O-F
Details Pane Right-Click Menu
Reformat Paragraph Shift + Ctrl + R
Preview/Print Current Template Ctrl + W
Insert Current
Template Ctrl + Insert
Template Pane
Open the templates drawer Spacebar
To expand a
template file cabinet or tree view Left Arrow
To collapse a template file cabinet
or tree view Right Arrow
Find Templates Select
a template or template file cabinet
and press Ctrl + F
Copy Template Text Select
the template and then press Ctrl + C
Insert Template Insert Select
a template and then press Ctrl +
Preview/Print Template Select
a template and then press Ctrl + W
Go to Default Select
a template or template file cabinet and press Ctrl + G
Mark as Default Select
a template and then press Ctrl + Space
View Template
Notes Ctrl + V
Template Editor
Edit Menu
Undo Ctrl + Z
Cut Ctrl + X
Copy Ctrl + C
Paste Ctrl + V
Select All Ctrl + A
Insert Patient Data (Object) Ctrl + I
Insert Template Field Ctrl + F
Check for Errors Ctrl + E
Preview/Print Template Ctrl + T
Check Grammar Ctrl + G
Check Spelling
Ctrl + S
Action Menu
New Template Alt-A-N
Generate Template Alt-A-G
Copy Template Alt-A-C
Paste Template Alt-A-P
Delete Template Alt-A-D
Sort Alt-A-O
Find Shared Templates Alt-A-S
Find
Personal Templates Alt-A-F
Collapse Shared Tree Alt-A-L
Collapse
Personal Tree Alt-A-A
Tools Menu
Edit Template Fields Alt-T-F
Import Template Alt-T-I
Export Template Alt-T-E
Refresh Templates Alt-T-R
Template Icon
Legend Alt-T-T
Consults Tab
View Menu
All Consults Alt-V-A
Consults by Status Alt-V-U
Consults by Service Alt-V-S
Consults by Date Range Alt-V-R
Custom View Alt-V-M
Save as Default View Alt-V-V
Return to Default View Alt-V-F
Icon Legend Alt-V-I
Action Menu
New | Consult Alt-A-N-C
New | Procedure Alt-A-N-P
Consult Tracking | Receive Alt-A-C-R
Consult Tracking | Schedule Alt-A-C-L
Consult Tracking | Cancel (Deny) Alt-A-C
Consult Tracking | Edit/Resubmit Alt-A-C-E
Consult Tracking | Discontinue Alt-A-C-D
Consult Tracking | Forward Alt-A-C-F
Consult Tracking | Add Comment Alt-A-C-A
Consult Tracking | Significant
Findings Alt-A-C-S
Consult Tracking | Administrative
Complete Alt-A-C-M
Consult Tracking | Display Details Alt-A-C-T
Consult Tracking | Display Results Alt-A-C-U
Consult
Tracking | Display SF 513 Alt-A-C-5
Consult Tracking | Print SF 513 Alt-A-C-P
Consult
Results:
Options Menu
Edit Templates Alt-O-T
Create New Template Alt-O-N
Edit Shared Templates Alt-O-S
Create New Shared Template Alt-O-C
Edit Template
Fields Alt-O-F
DC/Summ Tab
View Menu
Signed Summaries (All) Alt-V-S
Signed Summaries by Author Alt-V-A
Signed Summaries by Date Range Alt-V-R
Uncosigned Summaries Alt-V-C
Unsigned Summaries Alt-V-U
Custom View Alt-V-M
Save as Default View Alt-V-V
Return to Default View Alt-V-F
Details Alt-V-D
Icon Legend Alt-V-I
Action Menu
New Discharge Summary Alt-A-N or Shift + Ctrl + N
Make Addendum Alt-A-M or Shift + Ctrl + M
Change Title Alt-A-C or Shift + Ctrl + C
Reload Boilerplate Text Alt-A-B
Add to Signature List Alt-A-L
Delete Discharge Summary Alt-A-D or Shift + Ctrl + D
Edit Discharge Summary Alt-A-E or Shift + Ctrl + E
Save without Signature Alt-A-A or Shift + Ctrl + A
Sign Discharge Summary Now Alt-A-G or Shift + Ctrl + G
Identify
Additional Signers Alt-A-I
Options Menu
Edit Templates Alt-O-T
Create New Template Alt-O-N
Edit Shared Templates Alt-O-S
Create New Shared Template Alt-O-C
Edit Template
Fields Alt-O-F
Labs Tab
View Menu
Demographics Alt-V-M
Postings Alt-V-P
Reminder Alt-V-R
Reports Tab
View Menu
Demographics Alt-V-M
Postings Alt-V-P
Reminder Alt-V-R
View a
selected report Spacebar
Appendix C: JAWS Configuration Files
JAWS is a screen reader application that enables a computer
to verbally describe the controls and content of computer applications. For
example, in CPRS, when a user changes tabs, JAWS will speak the name of the
tab, such as “Orders," enabling the visually-challenged user to navigate
CPRS and complete necessary tasks.
Note: To install and use JAWS and the scripts
referred to below, the user must have administrative access to the workstation
JAWS will be installed on.
Developers have created specialized scripts and CPRS
components that enable
JAWS to work more effectively with CPRS. As part of the CPRS
GUI v.27 (OR*3.0*243) release a zip file (CPRS27_JAWS_SUPPORT_FILES.ZIP)
including the JAWS scripts and supporting files is being distributed.
Note: Users do not need to install the JAWS
scripts. When users place them in the appropriate directory, CPRS will
automatically install the scripts. The location is given below.
The improvements work only with JAWS 7.1 or later. However,
JAWS 8.0.2173 or later is best because it fixes a bug that caused CPRS to crash
when reading progress notes with JAWS. This fix is not in earlier versions of
JAWS 8.0.
Usually it is best for JAWS users stay up to date with the
latest releases of the product.
The following files are contained in the
CPRS27_JAWS_SUPPORT_FILES.ZIP file:
•
JAWS.SR - DLL used for
communication between JAWS and CPRS
•
JAWSUPDATE.EXE - Used
to update JAWS 7.1 to work with the component
•
VA508APP.jcf - JAWS
configuration file
•
VA508APP.JSS - JAWS
script file
•
VA508JAWS.jss - JAWS
script file
•
VA508JAWSDispatcher -
Application used for communication between JAWS and multiple applications using
the JAWS.SR DLL
•
VA508APP.jkm - JAWS
keyboard mapping file
•
VA508JAWS.jsd -
Documentation companion file to the VA508JAWS.jss script file
•
Vcredist_x86.exe is
the Microsoft Visual C++ 2005 Redistributable.
It is called by JAWSUpdate.exe.
To use the accessibility features, a user must copy these
files into Program
Files\Vista\Common Files, which is normally found on the
workstation at
C:\Program Files\Vista\Common Files. If the workstation is
running JAWS 8.0.2173 or higher, nothing further is required.
If the workstation is running an earlier version of JAWS
8.0, or JAWS 7.1.500, the user must go to Program Files\Vista\Common Files and
run JAWSUpdate.exe. JAWSUpdate installs a COM object for compatibility with
these versions.
Note: You must have administrative rights on the
machine to run JAWSUpdate.exe.
If the workstation is running a version of JAWS that is
older than v 7.1.500, the new accessibility features in CPRS will not function.
CPRS will function as it did without these changes, but the following error
message will display:
Using JAWS with CPRS
For JAWS and CPRS to work together, it is best to launch
JAWS first before launching CPRS. If JAWS has been closed for a while, but CPRS
has remained open, it would be best to shut down CPRS, start JAWS and then
relaunch CPRS. Starting JAWS first will help ensure that the two applications
communicate correctly.
Also, to run JAWS, the user must have administrative rights
on the workstation JAWS will be used on.
Appendix D – Error
Messages and Troubleshooting
This section includes general information regarding signing
outpatient controlled substance orders for the Electronic Prescribing of
Controlled Substance features (ePCS), errors the user might see, and some
possible causes.
Possible hardware problems:
o
The card reader is not working. To check, try the user’s card in another workstation’s
card reader.
o
The card is damaged or broken. To check, insert the card into a reader that you know
works.
What does a user need
in order to be able to digitally sign outpatient controlled substances
prescriptions?
Providers must have the following to be able to prescribe
outpatient controlled substance medication orders:
o
Must be an active user
o
Must have the provider
key
o
Must be authorized to
write medications in File 200
o
Must have the ORES key
o
DEA# (that has not
expired, but a date must be entered) or VA#
o
Assigned Pharmacy
schedules for which the provider can prescribe (some combination of schedules
2-5, or all schedules 2-5)
o
The ePCS USER
ENABLE/DISABLE option enabled
o
PIV or smart card and
PIN
o
Subject Alternative
Name (SAN), usually the user’s Outlook email address, if they have one,
which must be linked from the PIV or
smart card to the user’s VistA account
Is the user
prescribing from a remote location?
The ActivClient software must be installed on the remote
workstation or ePCS will not work. The user’s workstation must also have a card
reader.
What do the error
messages that the user might see during the signing process mean?
|
Error Message
|
Cause
|
|
Order for controlled substance could not be
completed. Provider does not have a current, valid DEA# on record and is
ineligible to sign the order.
|
There is no DEA Number in file 200 for this
provider, or this provider does not have a VA#, or this provider’s VA# could
not be used because either the facility DEA number is expired, or the
provider is not a VA provider (only VA providers may use VA numbers). Contact your CAC or support person who can
check on this for you.
Note: With patch OR*3*499, a provider must have a DEA number in the
NEW DEA#’s multiple field to order controlled substances. DEA numbers in the
obsolete DEA NUMBER field are ignored.
|
|
Order for controlled substance could not be
completed.
Provider is not authorized to prescribe
medications in Federal Schedule X [X is one of 2, 2N, 3, 3N, 4, or 5].
|
In the provider’s ePCS set up, they have not
been assigned permission to write for the specified schedule. Your CAC should
know who is responsible for assigning the schedules.
If a provider is using their individual DEA
number, the schedules associated with the DEA number in the DEA NUMBERS file
(#8991.9) are used to determine privileges. If using VA# or an institutional
DEA number to order controlled substances, the provider’s personal schedules
in file 200 are used to determine permissions.
Note: With patch OR*3*499, if a provider has more than one DEA number,
the error message specifically applies to the DEA number flagged ‘Use for
Inpatient Orders’ in the DEA NUMBERS file (#8991.9).
|
|
Order for controlled substance could not be
completed.
Provider’s DEA#
expired on DATE [ex:JAN 01, 2012] and no VA# is assigned. Provider is
ineligible to sign the order.
|
The text is clear. The provider’s DEA number
has expired and the provider does not have a VA number. Contact your ADPAC or
CAC to find out who enters credentialing information through the Data Entry
for ePrescribing Controlled Substances application to get this corrected.
Note: With patch OR*3*499, if a provider has more than one DEA number,
the error message specifically applies to the DEA number flagged ‘Use for
Inpatient Orders’ in the DEA NUMBERS file (#8991.9).
|
|
Digital Signing of Controlled
Substances is currently disabled for your
site.
|
The prescriber tries to sign and the ePCS
switch (OR EPCS SITE PARAMETER) is disabled for the site.
|
|
You are not currently permitted to digitally
sign Controlled Substances.
|
The prescriber tries to sign and the ePCS
switch (OR EPCS USERS PARAMETER) is disabled for the signer.
|
|
Problem getting PIN. Cannot Digitally Sign.
|
There are issues reading the PIV or smart
card/retrieving the PIN. Contact your CAC or ADPAC for assistance.
|
|
Card has been locked. Cannot Digitally Sign.
|
The card is
locked in CPRS after 3 failed attempts at PIV PIN entry. This error occurs
when the user attempts to sign while the card is locked. It will be
automatically unlocked after 15 minutes.
Warning: Be
careful! 5 consecutive incorrect PIN entry attempts will lock the card and
you will have to go to your PIV office station to reinstate or create a new
card!
|
|
Digital Signing has been cancelled.
|
The digital signature process has been
cancelled by CPRS. This error usually shows after another problem has
occurred.
|
|
Could not digitally sign. An error has
occurred: Hash generation failed.
|
The system has issues creating the hash. The
hash is created using the data from the order and a specific value. This
process is repeated in Pharmacy during finishing and the hash values are
compared to see if anything has been changed.
|
|
Please verify that you are logged on to the
CPRS system and that your PIV card is inserted. There is a possible mismatch
between your VistA last name and the last name of the certificate on your
card. If it matches and you are still experiencing issues, please contact
your card issuer for assistance.
|
When a user
tries to link his/her PIV card to another VistA user logged into CPRS, a
series of error messages will appear after PIN entry
Contact your
CAC or ADPAC for assistance.
|
|
CPRS was not able to link your VistA account
to a PIV card.
|
When a user
tries to link his/her PIV card to another VistA user logged into CPRS, a
series of error messages will appear after
PIN entry
|
|
89802006^Smart Card Reader not found
|
As stated, the card reader was not found.
Contact your local IRM shop.
|
|
Problems with verifying certificate chain of
authority
|
Network
problems connecting to the verifying servers Tumbleweed may not be installed
on the PKI Verify Server machine or the workstation or is not installed
correctly.
Contact your
CAC or ADPAC for assistance.
|
|
Valid Certificate not found
|
No valid certificate to use was found on the
card. Contact your CAC or ADPAC for assistance.
|
|
Returned from CertSignData with failure
|
Obtained a valid certificate, but failed to
sign data correctly. Contact your CAC or ADPAC for assistance.
|
|
Certificate not
valid:
89802019^Before
Cert effective date.
|
The current date when the user tries to sign
is before the certificate’s effective date. Contact your CAC or ADPAC for
assistance.
|
|
Certificate not
valid:
89802020^Certificate
expired.
|
The certificate
on the card has expired.
The PIV card needs to be renewed.
Contact your
PIV office.
|
|
Could not acquire context Last Error value was
“specific message for the error”
|
Often means that the ActivClient on that
machine needs to be reinstalled.
First, the user should try to digitally sign from another workstation,
and if that works, then it is probably ActivClient or the card reader hardware.
|
|
Invalid PIN entry - You only have ## attempts
left before it is locked.
|
This error
message displays when the user enters an incorrect PIN one or two times. The
message tells the user how many times another incorrect PIN can be entered
before CPRS locks ordering for the card. The order will be left unsigned.
Warning! If a
user incorrectly enters the PIN 5 consecutive times, the card will be
completely locked and will require the full PIV station to reinstate or
create a new card!
|
|
That was three (3) unsuccessful tries, the
Card Reader is Locked
|
The user
entered an incorrect PIN three consecutive times. CPRS locks access to the
card. The order will be left unsigned.
Warning! If a
user incorrectly enters the PIN 5 consecutive times, the card will be
completely locked and will require the full PIV station to reinstate or
create a new card!
|
|
PIN Entry was cancelled
|
The user cancelled PIN entry and stopped the
digital signature process. The order will be left unsigned.
|
|
Unable to read the information from your card.
Possible mismatch between your VistA last name and the last name of the
certificate on your card.
|
No matching
certificate found when trying to get the SAN from the PIV card to link.
Contact your
CAC or ADPAC for assistance.
|
|
Revocation failed - error: “specific text for
the error”
|
The revocation
server that checks to see if a certificate has been revoked or expired
couldn’t be reached over the network.
Contact your
CAC or ADPAC for assistance.
|
|
Could not open the Cert Store
|
This appears to
be a problem with ActivClient. Please check ActivClient and reinstall if
necessary.
Contact your
CAC or ADPAC for assistance.
|
|
Did not find a Cert
|
This error
comes from other programs outside of CPRS. The cause may not be as easily
determined as other errors.
Contact your
CAC or ADPAC for assistance.
|
|
89802010^Signature Error – “specific text for
the error”
|
This error comes from other programs outside
of CPRS. The cause may not be as easily determined as other errors.
|
|
89802009^Signature Check failed
|
This error
comes from other programs outside of CPRS. The cause may not be as easily
determined as other errors.
Contact your
CAC or ADPAC for assistance.
|
|
Digital signature verification failed:
“specific text for the error”
|
This error
comes from other programs outside of CPRS. The cause may not be as easily
determined as other errors.
Contact your
CAC or ADPAC for assistance.
|
|
Keyset error
|
This error
appears to relate a bad SAN being stored for the user.
Contact your
CAC or ADPAC for assistance.
|
AICS Automated
Information Collection System, formerly called Integrated Billing; software
developed at Albany IRMFO, supported by MCCR, producing scannable Encounter
Forms.
ASU Authorization/Subscription
Utility, a VistA application (initially released with TIU) that allows VAMCs to
assign privileges such as who can do what in ordering, signing, releasing
orders, etc.
CAC Clinical
Applications Coordinator. The CAC is a person at a hospital or clinic assigned
to coordinate the installation, maintenance and upgrading of CPRS and other
VistA software programs for the end users.
Chart Contents The
various components of the Patient Record, equivalent to the major categories of
a paper record; for example, Problem List, Progress Notes, Orders, Labs, Meds,
Reports, etc. In CPRS, these components are listed at the bottom of the screen,
to be selected individually for performing actions.
Consults Consult/Request
Tracking, a VistA product that is also part of CPRS (it can function as part of
CPRS, independently as a standalone package, or as part of TIU). It’s used to
request and track consultations or procedures from one clinician to another
clinician or service.
Cover Sheet A
screen of the CPRS patient chart that displays an overview of the patient’s
record.
CPRS Computerized
Patient Record System, the VistA package (in both GUI and character-based
formats) that provides access to most components of the patient chart.
CWAD Crises,
Warnings, Allergies/Adverse Reactions, and Directives. These are displayed on
the Cover Sheet of a patient’s computerized record, and can be edited,
displayed in greater detail, or added to. See Patient Postings.
D/C Summary Discharge
Summary; see below.
Discharge Summary A
component of TIU that can function as part of CPRS, Discharge Summaries are
recapitulations of a patient’s course of care while in the hospital.
GAF Global Assessment of Functioning is
a rating of overall psychological functioning on a scale of 0 – 100. The GAF
tab is available in the CPRS GUI in VA Mental Health facilities.
GUI Graphical
User Interface—a Windows-like screen with pulldown menus, icons, pointer
device, etc.
Health Summary A
VISTA product that can be viewed through CPRS, Health Summaries are components
of patient information extracted from other VistA applications.
ICD Stands
for International Classification of Diseases (ICD). ICD-9- CM is a classification system developed by
the World Health Organization (WHO) to classify diseases, and aggregate
diseases according to similar characteristics. To borrow an analogy from a
mailroom, ICD codes are like bins that correspond to different departments in a
building. A very important use of ICD coding is to represent patients’ diseases
for varying levels of financial reimbursement.
Imaging A
VistA product that is also a component of CPRS; it includes Radiology, X-rays,
Nuclear Medicine, etc.
Notifications Alerts
regarding specific patients that appear on the CPRS patient chart. They can be
responded to through “VA View Alerts.”
OE/RR Order
Entry/Results Reporting, a VistA product that evolved into the more
comprehensive CPRS.
Order Checking A
component of CPRS that reviews orders as they are placed to see if they meet
certain defined criteria that might cause the clinician placing the order to
change or cancel the order (e.g., duplicate orders, drug-drug/diet/lab test
interactions, etc.).
Order Sets Order
Sets are collections of related orders or Quick Orders, (such as Admission
Orders or Pre-Op Orders).
PCE Patient
Care Encounter is a VistA program that is part of the Ambulatory Data Capture
Project (ADCP) and also provides Clinical Reminders, which appear on Health
summaries.
PCMM Patient
Care Management Module, a VistA product that manages patient/provider lists.
PDMP Prescription
Drug-Monitoring Programs. Provides for ad-hoc
PDMP queries for retrieving the data and automatic generation of a progress
note for the medical record.
Patient Postings A
component of CPRS that includes messages about patients; an expanded version of
CWAD (see above).
Progress Notes A
component of TIU that can function as part of CPRS.
Quick Orders Quick Orders allow you to
enter many kinds of orders without going through as many steps. They are types
of orders that physicians have determined to be their most commonly ordered
items and that have standard collection times, routes, and other conditions.
Reports A
component of CPRS that includes Health Summary, Action Profile, and other
summarized reports of patient care.
SNOMED CT Systematized
Nomenclature of Medicine concept terms (SNOMED-CT) is a controlled terminology
developed by the College of American Pathologists to uniquely describe diseases
and their characteristics, and to organize them into a large hierarchy of all
diseases. In the mailroom analogy, SNOMED-CT codes are like individual
addresses on parcels.
TIU Text
Integration Utilities; a package for document handling, that includes Consults,
Discharge Summary, and Progress Notes, and will later add other document types
such as surgical pathology reports. TIU components can be accessed for
individual patients through the CPRS, or for multiple patients through the TIU
interface.
VISN Veterans
Information System Network is the collective name of the regional organizations
that manage computerization within a region.
VistA Veterans
Information Systems Technology Architecture, the new name for DHCP.
